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Sample records for understanding anorexia nervosa

  1. Understanding the 'Anorexic Voice' in Anorexia Nervosa.

    Science.gov (United States)

    Pugh, Matthew; Waller, Glenn

    2017-05-01

    In common with individuals experiencing a number of disorders, people with anorexia nervosa report experiencing an internal 'voice'. The anorexic voice comments on the individual's eating, weight and shape and instructs the individual to restrict or compensate. However, the core characteristics of the anorexic voice are not known. This study aimed to develop a parsimonious model of the voice characteristics that are related to key features of eating disorder pathology and to determine whether patients with anorexia nervosa fall into groups with different voice experiences. The participants were 49 women with full diagnoses of anorexia nervosa. Each completed validated measures of the power and nature of their voice experience and of their responses to the voice. Different voice characteristics were associated with current body mass index, duration of disorder and eating cognitions. Two subgroups emerged, with 'weaker' and 'stronger' voice experiences. Those with stronger voices were characterized by having more negative eating attitudes, more severe compensatory behaviours, a longer duration of illness and a greater likelihood of having the binge-purge subtype of anorexia nervosa. The findings indicate that the anorexic voice is an important element of the psychopathology of anorexia nervosa. Addressing the anorexic voice might be helpful in enhancing outcomes of treatments for anorexia nervosa, but that conclusion might apply only to patients with more severe eating psychopathology. Copyright © 2016 John Wiley & Sons, Ltd. Experiences of an internal 'anorexic voice' are common in anorexia nervosa. Clinicians should consider the role of the voice when formulating eating pathology in anorexia nervosa, including how individuals perceive and relate to that voice. Addressing the voice may be beneficial, particularly in more severe and enduring forms of anorexia nervosa. When working with the voice, clinicians should aim to address both the content of the voice and how

  2. Anorexia nervosa

    Science.gov (United States)

    ... therapy are used to treat people with anorexia: Cognitive behavioral therapy (a type of talk therapy), group therapy, and ... 2/2016 Updated by: Fred K. Berger, MD, addiction and forensic psychiatrist, Scripps Memorial Hospital, La Jolla, ...

  3. Understanding the Relation between Anorexia Nervosa and Bulimia Nervosa in a Swedish National Twin Sample

    Science.gov (United States)

    Bulik, Cynthia M; Thornton, Laura; Root, Tammy L.; Pisetsky, Emily M.; Lichtenstein, Paul; Pedersen, Nancy L.

    2010-01-01

    Background We present a bivariate twin analysis of anorexia nervosa (AN) and bulimia nervosa (BN) to determine the extent to which shared genetic and environmental factors contribute to liability to these disorders. Method Focusing on females from the Swedish Twin study of Adults: Genes and Environment (STAGE) (N=7000), we calculated heritability estimates for narrow and broad AN and BN and estimated their genetic correlation. Results In the full model, the heritability estimate for narrow AN was (a2 = .57; 95% CI: .00, .81) and for narrow BN (a2 = .62; 95% CI: .08, .70) with the remaining variance accounted for by unique environmental factors. Shared environmental factors estimates were (c2 = .00; 95% CI: .00, .67) for AN and (c2 = .00; 95% CI: .00, .40) for BN. Moderate additive genetic (.46) and unique environmental (.42) correlations between AN and BN were observed. Heritability estimates for broad AN were lower (a2 = .29; 95% CI: .04, .43) than for narrow AN, but estimates for broad BN were similar to narrow BN. The genetic correlation for broad AN and BN was .79 and the unique environmental correlation was .44. Conclusions We highlight the contribution of additive genetic factors to both narrow and broad AN and BN and demonstrate a moderate overlap of both genetic and unique environmental factors that influence the two conditions. Common concurrent and sequential comorbidity of AN and BN can in part be accounted for by shared genetic and environmental influences on liability although independent factors also operative. PMID:19828139

  4. Cardiac changes in anorexia nervosa.

    Science.gov (United States)

    Spaulding-Barclay, Michael A; Stern, Jessica; Mehler, Philip S

    2016-04-01

    Introduction Anorexia nervosa is an eating disorder, which is associated with many different medical complications as a result of the weight loss and malnutrition that characterise this illness. It has the highest mortality rate of any psychiatric disorder. A large portion of deaths are attributable to the cardiac abnormalities that ensue as a result of the malnutrition associated with anorexia nervosa. In this review, the cardiac complications of anorexia nervosa will be discussed. A comprehensive literature review on cardiac changes in anorexia nervosa was carried out. There are structural, functional, and rhythm-type changes that occur in patients with anorexia nervosa. These become progressively significant as ongoing weight loss occurs. Cardiac changes are inherent to anorexia nervosa and they become more life-threatening and serious as the anorexia nervosa becomes increasingly severe. Weight restoration and attention to these cardiac changes are crucial for a successful treatment outcome.

  5. Biomarkers for anorexia nervosa

    DEFF Research Database (Denmark)

    Sjøgren, Jan Magnus

    2017-01-01

    Biomarkers for anorexia nervosa (AN) which reflect the pathophysiology and relate to the aetiology of the disease, are warranted and could bring us one step closer to targeted treatment of AN. Some leads may be found in the biochemistry which often is found disturbed in AN, although normalization...

  6. Case 39: Anorexia nervosa

    Science.gov (United States)

    Anorexia nervosa is a disease affecting primarily young women who have distorted body images. Although their weight is less than 30 percent under ideal body weight, they see themselves as overweight. Anorectics often use diuretic and laxative agents to accomplish their weight loss. Patients with bul...

  7. Tuberculosis and anorexia nervosa

    African Journals Online (AJOL)

    recently our experience in the Eating Disorders Unit at Tara, where three patients with pulmonary tuberculosis were only diagnosed after admission for treatment of anorexia nervosa.· It appears that despite the presence of a persistent dry cough in each case, no investigation was undertaken. Did demographic stereotyping ...

  8. Anorexia Nervosa and Bulimia.

    Science.gov (United States)

    Csapo, Marg

    1987-01-01

    The article reviews the literature on anorexia nervosa, with or without bulimia, and presents a comprehensive picture of this eating disorder, focusing on terminology, historical references, prevalence, prognosis, classification, diagnostic criteria, physical and psychological characteristics, evolution of the disability, etiology, treatment, and…

  9. Anorexia nervosa en adolescenten

    NARCIS (Netherlands)

    van Elburg, A A; Danner, U N

    2015-01-01

    BACKGROUND: Anorexia nervosa (AN), which is the most serious of the eating disorders, starts earlier in life and often continues into adulthood. AIM: To discuss the typical features of AN in adolescents. METHOD: We present an overview based on the literature about AN in adolescents and on analysis

  10. Biological Aspects of Anorexia Nervosa and Bulimia Nervosa.

    Science.gov (United States)

    Kaplan, Allan S.; Woodside, D. Blake

    1987-01-01

    Reviews biological factors relevant to the understanding of anorexia nervosa and bulimia nervosa. Considers the physical presentation of these disorders; the medical complications of starvation, binging, and purging; and the cognitive and behavioral effects of starvation. Reviews neurophysiological and neurochemical aspects of these illnesses and…

  11. Dopamine and anorexia nervosa.

    Science.gov (United States)

    Södersten, P; Bergh, C; Leon, M; Zandian, M

    2016-01-01

    We have suggested that reduced food intake increases the risk for anorexia nervosa by engaging mesolimbic dopamine neurons, thereby initially rewarding dieting. Recent fMRI studies have confirmed that dopamine neurons are activated in anorexia nervosa, but it is not clear whether this response is due to the disorder or to its resulting nutritional deficit. When the body senses the shortage of nutrients, it rapidly shifts behavior toward foraging for food as a normal physiological response and the mesolimbic dopamine neurons may be involved in that process. On the other hand, the altered dopamine status of anorexics has been suggested to result from a brain abnormality that underlies their complex emotional disorder. We suggest that the outcomes of the treatments that emerge from that perspective remain poor because they target the mental symptoms that are actually the consequences of the food deprivation that accompanies anorexia. On the other hand, a method that normalizes the disordered eating behavior of anorexics results in much better physiological, behavioral, and emotional outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. [Franz Kafka's anorexia nervosa].

    Science.gov (United States)

    Fichter, M M

    1988-07-01

    The evidence for the hypothesis that the poet Franz Kafka had suffered from an atypical anorexia nervosa is presented. Kafka was slim and underweight throughout his life and showed an ascetic attitude and abjuration of physical enjoyment and pleasure (fasting, vegetarianism, sexual abstinence, emphasis on physical fitness). The analysis is mainly based on Kafka's own descriptions in his letters, diaries, and literary work. Kafka was achievement oriented, reported many sadomasochistic fantasies, and had an anancastic (obsessive-compulsive) depressive personality. In addition there is evidence for a disturbed psychosexual and gender identity development. Our results concerning Kafka's psychopathology do not question his genius as a poet.

  13. The Enigmatic Persistence of Anorexia Nervosa

    Science.gov (United States)

    Walsh, B. Timothy

    2014-01-01

    Objective In this review, based on recent advances in cognitive neuroscience, the author presents a formulation in which the marked persistence of anorexia nervosa can be usefully understood as a well-ingrained maladaptive habit. Method The author reviewed the relevant literature on the development and course of anorexia nervosa and interpreted critical features in light of developments in cognitive neuroscience. Results Anorexia nervosa is a well characterized disorder with remarkable persistence both across history and among affected individuals. Food restriction, the salient behavioral feature of the disorder, often begins innocently but gradually takes on a life of its own. Over time, it becomes highly entrenched and resistant to change through either psychological or pharmacological treatment. Cognitive neuroscience has described two related but distinct processes that underlie the acquisition of new patterns of behavior, namely, action-outcome and stimulus-response learning. It is likely that both processes are engaged in the development of anorexia nervosa and that stimulus-response learning (that is, habit formation) is critical to the persistence of the dieting behavior. Conclusions The formulation of the dieting behavior characteristic of anorexia nervosa as a well-entrenched habit provides a basis for understanding the striking persistence of this disorder. This model helps explain the resistance of anorexia nervosa to interventions that have established efficacy in related disorders and implies that addressing the dieting behavior is critical, especially early in the course of the illness, before it has become ingrained. PMID:23429750

  14. Anorexia Nervosa: Sociocultural Factors and Treatment.

    Science.gov (United States)

    Williams, Jennifer

    This paper examines how the epidemiological findings of anorexia nervosa lead theorists to speculate a correlation between sociocultural factors and the development of anorexia nervosa. A section on the essential features of anorexia nervosa identifies five primary characteristics of anorexia: (1) severe weight loss; (2) a disturbance of body…

  15. PSYCHOPATHOLOGICAL ASPECTS OF ANOREXIA NERVOSA

    Directory of Open Access Journals (Sweden)

    A. E. Bobrov

    2015-01-01

    Full Text Available Prevalence of anorexia nervosa among women is 0,5%, whereas mortality related to this disorder amounts to 5–17%. Psychopathological structure of anorexia nervosa implies abnormalities of behavior as well as those of motivation and volition, thinking, perception and appreciation. In addition, mental abnormalities typical for this disorder are evident in regulation of emotions, specific personality traits and self-consciousness. The key psychopathological feature of patients with anorexia nervosa is a lack of cognitive and personal differentiation that calls forth impairments of self-concept and self-image. Anorexia nervosa should be differentiated from depression and schizophrenic spectrum disorders. Its etiology and pathogenesis are related both to hereditary and psychosocial factors. Of great importance are psychoendocrine abnormalities, however their role is still insufficiently elucidated.

  16. Bone health in anorexia nervosa

    Science.gov (United States)

    Misra, Madhusmita; Klibanski, Anne

    2013-01-01

    Purpose of review Anorexia nervosa is associated with low bone mineral density (BMD), concerning for an increased risk of fractures, and decreased bone accrual in adolescents, concerning for suboptimal peak bone mass. This review discusses causes of impaired bone health in anorexia nervosa and potential therapeutic strategies. Recent findings Low BMD in anorexia nervosa is consequent to decreased lean mass, hypogonadism, low insulin-like growth factor-1 (IGF-1), relative hypercortisolemia and alterations in hormones impacted by energy availability. Weight gain causes some improvement in bone accrual, but not to the extent observed in controls, and vitamin D supplementation does not increase BMD. Oral estrogen is not effective in increasing BMD, likely from IGF-1 suppressive effects. In contrast, transdermal estrogen replacement is effective in increasing bone accrual in adolescents with anorexia nervosa, although not to the extent seen in controls. Recombinant human IGF-1 increases bone formation in adolescents, and with oral estrogen increases BMD in adults with anorexia nervosa. Bisphosphonates increase BMD in adults, but not in adolescents, and should be used cautiously given their long half-life. Summary Further investigation is necessary to explore therapies for low BMD in anorexia nervosa. Weight gain is to be encouraged. Transdermal estrogen in adolescents, and bisphosphonates in adults, have a potential therapeutic role. PMID:21897220

  17. Medical Complications of Anorexia Nervosa and Bulimia.

    Science.gov (United States)

    Westmoreland, Patricia; Krantz, Mori J; Mehler, Philip S

    2016-01-01

    Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Homeostasis in anorexia nervosa

    Directory of Open Access Journals (Sweden)

    Per eSodersten

    2014-08-01

    Full Text Available Brainstem and hypothalamic orexigenic/anorexigenic networks are thought to maintain body weight homeostasis in response to hormonal and metabolic feedback from peripheral sites. This approach has not been successful in managing over- and underweight patients. It is suggested that concept of homeostasis has been misinterpreted; rather than exerting control, the brain permits eating in proportion to the amount of physical activity necessary to obtain food. In support, animal experiments have shown that while a hypothalamic orexigen excites eating when food is abundant, it inhibits eating and stimulates foraging when food is in short supply. As the physical price of food approaches zero, eating and body weight increase without constraints. Conversely, in anorexia nervosa body weight is homeostatically regulated, the high level of physical activity in anorexia is displaced hoarding for food that keeps body weight constantly low. A treatment based on this point of view, providing patients with computerized mealtime support to re-establish normal eating behavior, has brought 75% of patients with eating disorders into remission, reduced the rate of relapse to 10%, and eliminated mortality.

  19. Adolescent Eating Disorder: Anorexia Nervosa.

    Science.gov (United States)

    Muuss, Rolf E.

    1985-01-01

    Examines anorexia nervosa, an eating disorder seen with increasing frequency, especially among adolescent girls. Presents five theories about causation, discusses early characteristics, typical family patterns, physical and medical characteristics, social adjustment problems, and society's contribution to anorexia. Describes course of the…

  20. Anorexia nervosa in Czech republic

    OpenAIRE

    HEJNOVÁ, Jana

    2017-01-01

    The thesis focuses on anorexia from the onset of the disease to the possible treatment in the Czech Republic. The theoretical part defines anorexia nervosa, offers insight into potential risk factors and also concentrates on situations that can cause anorexia. Next, this part provides a basic overview of a balanced diet and informs about the use of social work in prevention and follow-up care. Furthermore, it summarizes medical care and therapies used in the treatment of this disease. The pra...

  1. The incidence of anorexia nervosa on Curacao

    NARCIS (Netherlands)

    Hoek, HW; van Harten, PN; Hermans, KME; Katzman, MA; Matroos, GE; Susser, ES

    Objective: Although anorexia nervosa was once thought to occur only in affluent societies, cases have now been documented across the globe. To examine whether anorexia nervosa emerges in societies undergoing socioeconomic transition, the authors studied the incidence of anorexia nervosa on the

  2. Anorexia Nervosa and Bone

    Science.gov (United States)

    Misra, Madhusmita; Klibanski, Anne

    2014-01-01

    Anorexia nervosa (AN) is a condition of severe low weight that is associated with low bone mass, impaired bone structure and reduced bone strength, all of which contribute to increased fracture risk., Adolescents with AN have decreased rates of bone accrual compared with normal-weight controls, raising addition concerns of suboptimal peak bone mass and future bone health in this age group. Changes in lean mass and compartmental fat depots, hormonal alterations secondary to nutritional factors contribute to impaired bone metabolism in AN. The best strategy to improve bone density is to regain weight and menstrual function. Oral estrogen-progesterone combinations are not effective in increasing bone density in adults or adolescents with AN, and transdermal testosterone replacement is not effective in increasing bone density in adult women with AN. However, physiologic estrogen replacement as transdermal estradiol with cyclic progesterone does increase bone accrual rates in adolescents with AN to approximate that in normal-weight controls, leading to a maintenance of bone density Z-scores. A recent study has shown that risedronate increases bone density at the spine and hip in adult women with AN. However, bisphosphonates should be used with great caution in women of reproductive age given their long half-life and potential for teratogenicity, and should be considered only in patients with low bone density and clinically significant fractures when non-pharmacological therapies for weight gain are ineffective. Further studies are necessary to determine the best therapeutic strategies for low bone density in AN. PMID:24898127

  3. Death Related Themes in Anorexia Nervosa: A Practical Exploration.

    Science.gov (United States)

    Russell, Janice; And Others

    1990-01-01

    Explored death-related themes in psychodynamic etiology of anorexia nervosa by comparing anorexic adolescent patients (n=28) to age-matched controls (n=238). Results suggest that death-related themes are of significance in the understanding and management of anorexia nervosa. (Author/ABL)

  4. Reproductive issues in anorexia nervosa

    Science.gov (United States)

    Hoffman, Elizabeth R; Zerwas, Stephanie C; Bulik, Cynthia M

    2011-01-01

    Despite a high prevalence of menstrual irregularities, women with anorexia nervosa are becoming pregnant. The physical and psychological demands of pregnancy and motherhood can represent an immense challenge for women already struggling with the medical and psychological stress of an eating disorder. This article summarizes key issues related to reproduction in women with anorexia nervosa, highlighting the importance of preconception counseling, adequate gestational weight gain, and sufficient pre- and post-natal nutrition. Postpartum issues including eating disorder symptom relapse, weight loss, breastfeeding, and risk of perinatal depression and anxiety are also discussed. PMID:22003362

  5. [Menstrual dysfunction in anorexia nervosa].

    Science.gov (United States)

    Jagielska, Gabriela; Wolańczyk, Tomasz; Osuch, Beata

    2010-01-01

    One of the symptoms of anorexia nervosa (a.n.) is cessation of pubescence or secondary amenorrhea. Their origin in anorexia nervosa is multifactorial, partly resulting from starvation-induced hipogonadism. Amenorrhea in a.n. may persist despite weight recovery and is often related to osteoporosis. The authors' present causes of amenorrhea and its persisting in a.n., pointing to the factors influencing prognosis according to resumption of menses. They also review reports of hormonal replacement therapy in this group of patients.

  6. Psychosocial Treatments in Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Necati Serkut Bulut

    2017-09-01

    Full Text Available Despite its severe morbidity and mortality, studies regarding the psychosocial treatments of anorexia nervosa are limited in number. This paper aims to present the general outlines of various psychosocial interventions developed for the treatment of anorexia nervosa and to provide an up-to-date review of the randomized-controlled studies on the effectiveness of these approaches. Reviewed studies were classified by age spectrum of samples under two main headings: adolescents and mixed samples of adults and adolescents. Specific issues about other variables were then discussed separately. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2017; 9(3.000: 329-345

  7. Adolescent Boys and Anorexia Nervosa.

    Science.gov (United States)

    Romeo, Felicia

    1994-01-01

    Notes that there has been steady increase in reported incidence of male adolescents with anorexia nervosa, from approximately 5% in 1985 to as much as 10% in 1987. Considers role of educators and counselors in early identification of this disorder, noting that young anorectic males have better prognosis for recovery if they receive treatment in…

  8. A longitudinal investigation of mortality in anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Franko, Debra L; Keshaviah, Aparna; Eddy, Kamryn T; Krishna, Meera; Davis, Martha C; Keel, Pamela K; Herzog, David B

    2013-08-01

    OBJECTIVE Although anorexia nervosa has a high mortality rate, our understanding of the timing and predictors of mortality in eating disorders is limited. The authors investigated mortality in a long-term study of patients with eating disorders. METHOD Beginning in 1987, 246 treatment-seeking female patients with anorexia nervosa or bulimia nervosa were interviewed every 6 months for a median of 9.5 years to obtain weekly ratings of eating disorder symptoms, comorbidity, treatment participation, and psychosocial functioning. From January 2007 to December 2010 (median follow-up of 20 years), vital status was ascertained with a National Death Index search. RESULTS Sixteen deaths (6.5%) were recorded (lifetime anorexia nervosa, N=14; bulimia nervosa with no history of anorexia nervosa, N=2). The standardized mortality ratio was 4.37 (95% CI=2.4-7.3) for lifetime anorexia nervosa and 2.33 (95% CI=0.3-8.4) for bulimia nervosa with no history of anorexia nervosa. Risk of premature death among patients with lifetime anorexia nervosa peaked within the first 10 years of follow-up, resulting in a standardized mortality ratio of 7.7 (95% CI=3.7-14.2). The standardized mortality ratio varied by duration of illness and was 3.2 (95% CI=0.9-8.3) for patients with lifetime anorexia nervosa for 0 to 15 years (4/119 died), and 6.6 (95% CI=3.2-12.1) for those with lifetime anorexia nervosa for >15 to 30 years (10/67 died). Multivariate predictors of mortality included alcohol abuse, low body mass index, and poor social adjustment. CONCLUSIONS These findings highlight the need for early identification and intervention and suggest that a long duration of illness, substance abuse, low weight, and poor psychosocial functioning raise the risk for mortality in anorexia nervosa.

  9. Treatments of medical complications of anorexia nervosa and bulimia nervosa

    OpenAIRE

    Mehler, Philip S; Krantz, Mori J; Sachs, Katherine V

    2015-01-01

    Inherent to anorexia nervosa and bulimia nervosa are a plethora of medical complications which correlate with the severity of weight loss or the frequency and mode of purging. Yet, the encouraging fact is that most of these medical complications are treatable and reversible with definitive care and cessation of the eating-disordered behaviours. Herein, these treatments are described for both the medical complications of anorexia nervosa and those which are a result of bulimia nervosa.

  10. Treatments of medical complications of anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Mehler, Philip S; Krantz, Mori J; Sachs, Katherine V

    2015-01-01

    Inherent to anorexia nervosa and bulimia nervosa are a plethora of medical complications which correlate with the severity of weight loss or the frequency and mode of purging. Yet, the encouraging fact is that most of these medical complications are treatable and reversible with definitive care and cessation of the eating-disordered behaviours. Herein, these treatments are described for both the medical complications of anorexia nervosa and those which are a result of bulimia nervosa.

  11. Endocrinology of anorexia nervosa in young people: recent insights

    Science.gov (United States)

    Singhal, Vibha; Misra, Madhusmita; Klibanski, Anne

    2014-01-01

    Purpose of review Anorexia nervosa is among the most prevalent chronic medical conditions in young adults. It has acute as well as long-term consequences, some of which, such as low bone mineral density (BMD), are not completely reversible even after weight restoration. This review discusses our current understanding of endocrine consequences of anorexia nervosa. Recent findings Anorexia nervosa is characterized by changes in multiple neuroendocrine axes including acquired hypogonadotropic hypogonadism, growth hormone resistance with low insulin-like growth factor-1 (likely mediated by fibroblast growth factor-1), relative hypercortisolemia, alterations in adipokines such as leptin, adiponectin and resistin, and gut peptides including ghrelin, PYY and amylin. These changes in turn contribute to low BMD. Studies in anorexia nervosa have demonstrated abnormalities in bone microarchitecture and strength, and an association between increased marrow fat and decreased BMD. One study in adolescents reported an improvement in BMD following physiologic estrogen replacement, and another in adults demonstrated improved BMD following risedronate administration. Brown adipose tissue is reduced in anorexia nervosa, consistent with an adaptive response to the energy deficit state. Summary Anorexia nervosa is associated with widespread physiologic adaptations to the underlying state of undernutrition. Hormonal changes in anorexia nervosa affect BMD adversely. Further investigation is underway to optimize therapeutic strategies for low BMD. PMID:24275621

  12. Family Psychic Transmission and Anorexia Nervosa

    OpenAIRE

    Valdanha-Ornelas, Élide Dezoti; Santos, Manoel Antônio dos

    2016-01-01

    Abstract Studies show that family relationships can act as mediating agents in triggering and maintaining the symptoms of anorexia nervosa (AN), especially the mother-daughter relationship configuration, which contains unconscious elements transmitted inter-generationally. This study aimed to understand the role of intergenerational psychic transmission in the articulation of anorexic symptoms in a young woman in treatment. Three generations of women of the same family were interviewed: mater...

  13. Endocrine Dysregulation in Anorexia Nervosa Update

    Science.gov (United States)

    2011-01-01

    Context: Anorexia nervosa is a primary psychiatric disorder with serious endocrine consequences, including dysregulation of the gonadal, adrenal, and GH axes, and severe bone loss. This Update reviews recent advances in the understanding of the endocrine dysregulation observed in this state of chronic starvation, as well as the mechanisms underlying the disease itself. Evidence Acquisition: Findings of this update are based on a PubMed search and the author's knowledge of this field. Evidence Synthesis: Recent studies have provided insights into the mechanisms underlying endocrine dysregulation in states of chronic starvation as well as the etiology of anorexia nervosa itself. This includes a more complex understanding of the pathophysiologic bases of hypogonadism, hypercortisolemia, GH resistance, appetite regulation, and bone loss. Nevertheless, the etiology of the disease remains largely unknown, and effective therapies for the endocrine complications and for the disease itself are lacking. Conclusions: Despite significant progress in the field, further research is needed to elucidate the mechanisms underlying the development of anorexia nervosa and its endocrine complications. Such investigations promise to yield important advances in the therapeutic approach to this disease as well as to the understanding of the regulation of endocrine function, skeletal biology, and appetite regulation. PMID:21976742

  14. Applying neurobiology to the treatment of adults with anorexia nervosa.

    Science.gov (United States)

    Hill, Laura; Peck, Stephanie Knatz; Wierenga, Christina E; Kaye, Walter H

    2016-01-01

    Anorexia nervosa is a severe, biologically based brain disorder with significant medical complications. It is critical that new, effective treatments are developed to interrupt the persistent course of the illness due to the medical and psychological sequelae. Several psychosocial, behavioral and pharmacologic interventions have been investigated in adult anorexia nervosa; however, evidence shows that their impact is weak and treatment effects are generally small. This paper describes a new neurobiological anorexia nervosa model that shifts focus from solely external influences, such as social and family, to include internal influences that integrate genetic and neurobiological contributions, across the age span. The model serves as a theoretical structure for a new, five-day treatment, outlined in this paper, targeting anorexia nervosa temperament, which integrates neurobiological dimensions into evidence-based treatment interventions. The treatment is in two phases. Phase I is a five day, 40 hour treatment for anorexia nervosa adults. Phase II is the follow-up and is currently being developed. Preliminary qualitative acceptability data on 37 adults with anorexia nervosa and 60 supports (e.g., spouses, parents, aunts, friends, partners, children of anorexia nervosa adults) are promising from Phase I. Clients with anorexia nervosa and their supports report that learning neurobiological facts improved their understanding of the illness and helped equip them with better tools to manage anorexia nervosa traits and symptoms. In addition, nutritional knowledge changed significantly. This is the first neurobiologically based, five-day treatment for adults with anorexia nervosa and their supports. It is a new model that outlines underlying genetic and neurobiological contributions to anorexia nervosa that serves as a foundation to treat both traits and symptoms. Preliminary qualitative findings are promising, with both clients and supports reporting that the

  15. Anorexia Nervosa/Bulimia: The Teenager's Dilemma.

    Science.gov (United States)

    Thompson, G. Sue

    Anorexia nervosa and bulimia are currently being studied with great intensity by the medical profession. Anorexia nervosa was first described in the medical literature in 1868, but was considered a rarity until the late 1930's. Bulimia was not identified in the medical literature until 1979. Recent studies suggest that approximately five percent…

  16. Understanding the Association of Impulsivity, Obsessions, and Compulsions with Binge Eating and Purging Behaviors in Anorexia Nervosa

    Science.gov (United States)

    Hoffman, Elizabeth R.; Gagne, Danielle A.; Thornton, Laura M.; Klump, Kelly L.; Brandt, Harry; Crawford, Steve; Fichter, Manfred M.; Halmi, Katherine A.; Johnson, Craig; Jones, Ian; Kaplan, Allan S.; Mitchell, James E.; Strober, Michael; Treasure, Janet; Woodside, D. Blake; Berrettini, Wade H.; Kaye, Walter H.; Bulik, Cynthia M.

    2012-01-01

    Objective To further refine our understanding of impulsivity, obsessions, and compulsions in anorexia nervosa (AN) by isolating which behaviors—binge eating, purging, or both—are associated with these features. Methods We conducted regression analyses with binge eating, purging, and the interaction of binge eating with purging as individual predictors of scores for impulsivity, obsessions, and compulsions in two samples of women with AN (n = 1373). Results Purging, but not binge eating, was associated with higher scores of impulsivity, obsessions and compulsions. Purging was also associated with worst eating rituals and with worst eating preoccupations. Conclusion Our results suggest that purging, compared with binge eating, may be a stronger correlate of impulsivity, obsessions, and compulsions in AN. PMID:22351620

  17. Anorexia nervosa, liquorice and hypokalaemic myopathy.

    OpenAIRE

    Nightingale, S.; Smith, P. E.; Turnbull, D. M.

    1981-01-01

    A patient with a past history of anorexia nervosa developed a hypokalaemic myopathy following a 'flu-like illness. Although she was apparently in remission from anorexia nervosa, the diet was found to be markedly abnormal with an excessive ingestion of liquorice and a low potassium salt intake. The clinical features and investigations, including muscle biopsy, are described. The patient is compared, with 2 reported cases of liquorice-induced myopathy, and the relationship between anorexia ner...

  18. Anorexia nervosa: un estudio de casos

    Directory of Open Access Journals (Sweden)

    Lillyana Zusman Tinman

    2013-09-01

    Full Text Available La Anorexia Nervosa es un trastorno de alimentación que se define (etimológicamente como una "pérdida nerviosa del apetito". Se caracteriza por la actitud consciente, voluntaria y rotunda de los sujetos  de tener un exceso de peso que intentan modificar por vía de la inanición. A partir del estudio de casos, se propone la distinción entre una Anorexia Nervosa Estructural -aquella en la que predomina el conflicto intrapsíquico primario y arcaico, y que manifiesta una conducta aislada y retraída- y una Anorexia Nervosa Reactiva, aquella en la que predomina un conflicto intrafamiliar algo más posterior y, por lo tanto, una personalidad más abierta y compatible con el medio. Anorexia Nervosa is an Eating Disorder defined (etimoligacally as a "nervouse loss of apetite". It is characterized by a conscious, voluntary and categoric attitude of the sick patient to refrain from eating. He/she has a firm conviction of having excess weight which they try to modify by starvation. Through a case study, a distinction between two types of Anorexia Nervosa is proposed: a Structural Anorexia Nervosa -in which an intrapsyhic, primary, arcaic conflic prevails, leading to an isolated, withdrawal conduct- and a Reactive Anorexia Nervosa, in which a later intrafamilial conflict prevails leading, therefore, to a more open personality, compatible with the enviroment.

  19. [Adolescent-onset anorexia nervosa

    Science.gov (United States)

    Feitlich, B W; Larino, M A; Cobelo, A; Cordás, T A

    2000-11-01

    OBJECTIVE: This paper is a review on the topic of adolescent-onset anorexia nervosa. According to the literature, this disorder presents high morbidity and mortality, with increasing incidence over the last decades, thus enhancing the importance of scientific investigation on the subject. METHODS: The authors performed a non-systematic review of the related literature and also reported their clinical experience. RESULTS: Age and gender are important risk factors. The peak of incidence occurs in adolescence and the prevalence is 9 times higher in females. It was initially believed that anorexia nervosa manifested itself only in higher socioeconomic levels, which are more highly exposed to the demands of western beauty standards. More recent studies have identified similar incidence of this disorder also in lower socioeconomic levels, rural areas and Asian communities. The clinical features are: refusal to maintain weight at or above a minimal normal weight for age; high, intense fear of gaining weight or becoming fat, even though underweight; disturbance in the way of experiencing one s body weight or shape, and amenorrhea. The most common physical complications are similar to those of chronic malnutrition and depression is the main comorbidity. CONCLUSIONS: Treatment should be multidisciplinary, taking into account the plurality of etiological factors. Family therapy plays an important role, particularly when this disorder manifests itself during adolescence.

  20. Anorexia Nervosa and Bulimia: A Research Review.

    Science.gov (United States)

    Sweeten, Mary K.

    1985-01-01

    The eating disorders called anorexia nervosa and bulimia are examined in terms of their symptomatology, etiology, and treatment, and in terms of how the extension home economist or teacher can help. Resources for additional information or help are listed. (CT)

  1. Treatment of Adolescents with Anorexia Nervosa.

    Science.gov (United States)

    Patel, Dilip R.; Pratt, Helen D.; Greydanus, Donald E.

    2003-01-01

    Reviews research on the treatment of adolescents with anorexia nervosa, including the general approach, treatment setting, treatment of medical complications, nutritional management, psychopharmacotherapy, psychotherapy, treatment efficacy and outcome studies, comparison studies, and prevention programs. (EV)

  2. Anorexia Nervosa: Adolescent Starvation by Choice.

    Science.gov (United States)

    Gilbert, Evelyn H.; DeBlassie, Richard R.

    1984-01-01

    Discusses anorexia nervosa in terms of symptoms, characteristics of patients, family relationship, and modes of treatment. Suggests that a combination of psychological and medical treatment is more effective than behavior modification. (JAC)

  3. Adolescence, Sexual Conflict, and Anorexia Nervosa.

    Science.gov (United States)

    Romeo, Felicia F.

    1984-01-01

    Suggests that the high incidence of anorexia nervosa in adolescent girls may be related to developmental sexual pressure. Symptoms appear with the onset of puberty and are related to physiological and psychological changes. (JAC)

  4. Jane: A Case Study in Anorexia Nervosa.

    Science.gov (United States)

    Willingham, Barbara

    1988-01-01

    The article reports the case history of a 15-year-old Australian girl with anorexia nervosa. Information is also given on prevalence, causes, definitions, and treatments including hospitalization, co-therapy, psychotherapy, behavior modification, family therapy, and counseling. (DB)

  5. Update on endocrine disturbances in anorexia nervosa

    DEFF Research Database (Denmark)

    Støving, R K; Hangaard, J; Hagen, C

    2001-01-01

    The marked endocrine changes that occur in anorexia nervosa have aroused a great deal of interest, and over the last decade much research has been conducted in this field. The endocrine disturbances are not specific to this disorder, as they also occur in starvation states secondary to other causes...... of the large body of literature concerning endocrine aspects of anorexia nervosa with the main focus on the latest results, which provide leads for potential etiological theories....

  6. [Anorexia nervosa and bulimia nervosa. Psychological considerations for its treatment].

    Science.gov (United States)

    Barriguete Meléndez, J Armando; Rojo, Luis; Emmelhainz, Marisa

    2004-11-01

    It is presented the current perspectives in the study and treatment of the eating disorders, in specific: anorexia nervosa and bulimia nervosa, epidemiology, and the interface among the different medical specialties, nutrition and sciences of the behavior, the diagnostic approaches, instruments and current therapeutic models.

  7. Bone Metabolism in Anorexia Nervosa

    Science.gov (United States)

    Fazeli, Pouneh K.; Klibanski, Anne

    2014-01-01

    Anorexia nervosa (AN), a psychiatric disorder predominantly affecting young women, is characterized by self-imposed chronic nutritional deprivation and distorted body image. AN is associated with a number of medical co-morbidities including low bone mass. The low bone mass in AN is due to an uncoupling of bone formation and bone resorption, which is the result of hormonal adaptations aimed at decreasing energy expenditure during periods of low energy intake. Importantly, the low bone mass in AN is associated with a significant risk of fractures and therefore treatments to prevent bone loss are critical. In this review, we discuss the hormonal determinants of low bone mass in AN and treatments that have been investigated in this population. PMID:24419863

  8. Anorexia Nervosa and Comorbid Psychopathology.

    Science.gov (United States)

    Marucci, Simonetta; Ragione, Laura Dalla; De Iaco, Giulia; Mococci, Tania; Vicini, Maria; Guastamacchia, Edoardo; Triggiani, Vincenzo

    2018-02-12

    There is great interest, supported by clinical experience, in the relationship between Eating Disorders (EDs) and psychiatric symptoms and diseases. The psychopathology of EDs is also referred to many risk and protective factors, and there is some evidence in the literature, also about genetic and neurobiological factors involved. EDs are often associated with pre-morbid psychiatric disorders, personality disorders, substance abuse, mood and anxiety disorders. The great amount of scientific articles dealing with the relationship between EDs and psychopathology confirms the complexity of these problems and the difficulties in diagnosis and treatment. The aim of this review is to examine and synthesize the recent scientific literature on this topic, in particular the complex relationship between Anorexia Nervosa (AN) and Neuropsychiatric Disorders. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  9. Endocrine Consequences of Anorexia Nervosa

    Science.gov (United States)

    Misra, Madhusmita; Klibanski, Anne

    2014-01-01

    Summary Anorexia nervosa (AN) is prevalent in adolescents and young adults, and endocrine changes include hypothalamic amenorrhea, a nutritionally acquired growth hormone resistance with low insulin like growth factor-1 (IGF-1), relative hypercortisolemia, decreases in leptin, insulin, amylin and incretins, and increases in ghrelin, PYY and adiponectin. These changes in turn have deleterious effects on bone, and may affect neurocognition, anxiety, depression and eating disorder psychopathology. Low bone density is particularly concerning; clinical fractures occur and changes in both bone microarchitecture and strength estimates have been reported. Recovery causes improvement of many, but not all, hormonal changes, and deficits in bone accrual may persist despite recovery. Physiologic, primarily transdermal, estrogen replacement increases bone density in adolescents, although catch-up is incomplete. In adults, oral estrogen co-administered with rhIGF-1 in one study, and bisphosphonates in another increased bone density, though not to normal. More studies are necessary to determine the optimal therapeutic approach in AN. PMID:24731664

  10. New Insights in Anorexia Nervosa

    Science.gov (United States)

    Gorwood, Philip; Blanchet-Collet, Corinne; Chartrel, Nicolas; Duclos, Jeanne; Dechelotte, Pierre; Hanachi, Mouna; Fetissov, Serguei; Godart, Nathalie; Melchior, Jean-Claude; Ramoz, Nicolas; Rovere-Jovene, Carole; Tolle, Virginie; Viltart, Odile; Epelbaum, Jacques

    2016-01-01

    Anorexia nervosa (AN) is classically defined as a condition in which an abnormally low body weight is associated with an intense fear of gaining weight and distorted cognitions regarding weight, shape, and drive for thinness. This article reviews recent evidences from physiology, genetics, epigenetics, and brain imaging which allow to consider AN as an abnormality of reward pathways or an attempt to preserve mental homeostasis. Special emphasis is put on ghrelino-resistance and the importance of orexigenic peptides of the lateral hypothalamus, the gut microbiota and a dysimmune disorder of neuropeptide signaling. Physiological processes, secondary to underlying, and premorbid vulnerability factors—the “pondero-nutritional-feeding basements”- are also discussed. PMID:27445651

  11. Epidemiology of anorexia nervosa in Japanese adolescents.

    Science.gov (United States)

    Hotta, Mari; Horikawa, Reiko; Mabe, Hiroyo; Yokoyama, Shin; Sugiyama, Eiko; Yonekawa, Tadato; Nakazato, Masamitsu; Okamoto, Yuri; Ohara, Chisato; Ogawa, Yoshihiro

    2015-01-01

    No epidemiologic survey examining eating disorders in Japan has been done at a national level since 1992. The prevalence of anorexia nervosa, as assessed by questionnaires to hospitals, is thought to be underestimated because patients with anorexia nervosa tend to avoid consultations. In conformity with the School Health and Safety Act of Japan, schools are required to have physicians perform a medical examination of students every year. The teachers in charge of health education and school physicians determine the height, weight, and health condition, and examine the medical records of each student. Therefore, we as members of the Survey Committee for Eating Disorders of the Japanese Ministry of Health, Labour, and Welfare conducted an epidemiologic survey using questionnaires sent to schools in seven prefectures to determine the current prevalence of anorexia nervosa among adolescents. We sent a questionnaire to elementary, junior high, and senior high schools. Questionnaires contained items on the number of students, patients with anorexia nervosa in each grade who were diagnosed by specialists, and students who the school physician strongly suspected to have anorexia nervosa but who did not undergo a clinical examination in a medical institution. We found patients of both sexes with anorexia nervosa aged 9-10 years in elementary schools. The point prevalence of anorexia nervosa for girls, including strongly suspected cases, in the three grades of junior high school and three grades of senior high school were 0-0.17 %, 0-0.21 %, 0.17-0.40 %, 0.05-0.56 %, 0.17-0.42 % and 0.09-0.43 %, respectively. We also confirmed a prominent sex difference in the prevalence of anorexia nervosa. The prevalence of boys was one third that of girls in some prefectures. One third to one half of diagnosed and strongly suspected students with anorexia nervosa had not received medical consultation or treatment. Although the prevalence of anorexia nervosa had regional differences

  12. Do Mortality Rates in Eating Disorders Change over Time? A Longitudinal Look at Anorexia Nervosa and Bulimia Nervosa

    Science.gov (United States)

    Franko, Debra L.; Keshaviah, Aparna; Eddy, Kamryn T.; Krishna, Meera; Davis, Martha C.; Keel, Pamela K.; Herzog, David B.

    2014-01-01

    Objective Although anorexia nervosa has a high mortality rate, our understanding of the timing and predictors of mortality in eating disorders is limited. The authors investigated mortality in a long-term study of patients with eating disorders. Method Beginning in 1987, 246 treatment-seeking women with anorexia nervosa or bulimia nervosa were interviewed every 6 months for a median of 9.5 years to obtain weekly ratings of eating disorder symptoms, comorbidity, treatment participation, and psychosocial functioning. From January 2007 to December 2010 (median follow-up of 20 years), vital status was ascertained with a National Death Index search. Results Sixteen deaths (6.5%) were recorded (lifetime anorexia nervosa, N=14; bulimia nervosa with no history of anorexia nervosa, N=2). The standardized mortality ratio was 4.37 [95% CI=2.4-7.3] for lifetime anorexia nervosa and 2.33 [95% CI=0.3-8.4] for bulimia nervosa with no history of anorexia nervosa. Risk of premature death among women with lifetime anorexia nervosa peaked within the first 10 years of follow-up resulting in a standardized mortality ratio of 7.7 [95% CI=3.7-14.2]. The standardized mortality ratio varied by duration of illness and was 3.2 [95% CI=0.9-8.3] for women with lifetime anorexia nervosa for 0-15 years (4/119 died), and 6.6 [95% CI=3.2-12.1] for women with lifetime anorexia nervosa for >15-30 years (10/67 died). Multivariate predictors of mortality included alcohol abuse (panorexia nervosa. PMID:23771148

  13. The diet of an individual diagnosed with anorexia nervosa

    OpenAIRE

    SRBOVÁ, Martina

    2015-01-01

    The aim of this Bachelor thesis entitled "A diet of individual with a diagnosis of anorexia nervosa" was to monitor the content and quality of the diet of people with a diagnosis of anorexia nervosa. Anorexia nervosa is a very serious disease belonging to the group of eating disorders. The prevalence of this disease increases, to which primarily affect media and requirements of today's society excessively slender figure, other factors that influence the formation of anorexia nervosa include b...

  14. Understanding Eating Disorders, Anorexia, Bulimia, and Binge-Eating

    Science.gov (United States)

    ... Navigation Bar Home Current Issue Past Issues Understanding Eating Disorders Past Issues / Spring 2008 Table of Contents For ... this page please turn Javascript on. Photo: iStock Eating disorders, such as anorexia nervosa, bulimia nervosa, and binge ...

  15. "Fasting Girls": Reflections on Writing the History of Anorexia Nervosa

    Science.gov (United States)

    Brumberg, Joan Jacobs

    1986-01-01

    Reflects on the history of anorexia nervosa among adolescent ("fasting") girls, suggesting that its psychodynamics have changed over time. Focuses on the social and cultural processes by which anorexia nervosa became a disease. Argues for a conception of anorexia nervosa that incorporates culture as well as biomedical and psychological…

  16. Hepatic Complications of Anorexia Nervosa.

    Science.gov (United States)

    Rosen, Elissa; Bakshi, Neeru; Watters, Ashlie; Rosen, Hugo R; Mehler, Philip S

    2017-11-01

    Anorexia nervosa (AN) has the highest mortality rate of all psychiatric illnesses due to the widespread organ dysfunction caused by the underlying severe malnutrition. Starvation causes hepatocyte injury and death leading to a rise in aminotransferases. Malnutrition-induced hepatitis is common among individuals with AN especially as body mass index decreases. Acute liver failure associated with coagulopathy and encephalopathy can rarely occur. Liver enzymes may also less commonly increase as part of the refeeding process due to hepatic steatosis and can be distinguished from starvation hepatitis by the finding of a fatty liver on ultrasonography. Individuals with AN and starvation-induced hepatitis are at increased risk of hypoglycemia due to depleted glycogen stores and impaired gluconeogenesis. Gastroenterology and hepatology consultations are often requested when patients with AN and signs of hepatitis are hospitalized. It should be noted that additional laboratory testing, imaging, or liver biopsy all have low diagnostic yield, are costly, and potentially invasive, therefore, not generally recommended for diagnostic purposes. While the hepatitis of AN can reach severe levels, a supervised increase in caloric intake and a return to a healthy body weight often quickly lead to normalization of elevated aminotransferases caused by starvation.

  17. Serotonin neurotransmission in anorexia nervosa.

    Science.gov (United States)

    Haleem, Darakhshan Jabeen

    2012-09-01

    Patients with anorexia nervosa (AN) show extreme dieting weight loss, hyperactivity, depression/anxiety, self-control, and behavioral impulsivity. 5-Hydroxytryptamine (5-HT; serotonin) is involved in almost all the behavioral changes observed in AN patients. Both genetic and environmental factors contribute toward the pathogenesis of AN. It is a frequent disorder among adolescent girls and young women and starts as an attempt to lose weight to look beautiful and attractive. Failure to see the turning point when fasting becomes unreasonable leads to malnutrition and AN. Tryptophan, the precursor of serotonin and an essential amino acid, is only available in the diet. It is therefore likely that excessive diet restriction and malnutrition decrease brain serotonin stores because the precursor is less available to the rate-limiting enzyme of 5-HT biosynthesis, which normally exists unsaturated with its substrate. Evidence shows that diet restriction-induced exaggerated feedback control over 5-HT synthesis and the smaller availability of tryptophan decreases serotonin neurotransmission at postsynaptic sites, leading to hyperactivity, depression, and behavioral impulsivity. A compensatory upregulation of postsynaptic 5-HT-1A receptors and hypophagic serotonin receptors may be involved in anxiety and suppression of appetite. It is suggested that tryptophan supplementation may improve pharmacotherapy in AN.

  18. [Anorexia nervosa in German medical literature 1900 to 1945. The role of anorexia nervosa in the origin of psychosomatic medicine].

    Science.gov (United States)

    Habermas, T

    1992-01-01

    German-language publications on anorexia nervosa and Simmonds' disease from between 1900 and 1945 are reviewed in order to trace factors inherent in medical thinking which have mostly hindered German-language medicine in understanding anorexia nervosa. It is demonstrated that a) the few German-language physicians who did describe central and possible characteristics of a.n. (weight-phobia, overactivity, bulimia, self-induced vomiting) were enabled to do so by valuing detailed clinical description, also of psychic characteristics, and an interest in the neuroses; b) the concept of anorexia nervosa was better known than previously assumed, though largely misunderstood; c) typical diagnostic misinterpretations led to typical biases in the description of the syndrome; d) in Germany more than in other countries a.n. was confounded with Simmonds' disease; and e) in addition to other factors, one reason for this lay in the 'holistic' ideal of psychosomatic medicine in the 1930s.

  19. On the uses of history in psychiatry: diagnostic implications for anorexia nervosa.

    Science.gov (United States)

    Habermas, Tilmann

    2005-09-01

    The current study demonstrates that recent attempts to equate anorexia nervosa with any form of voluntary self-starvation are not justified. Three arguments are critically reconsidered: That weight phobia was not part of early case reports on anorexia nervosa, that weight phobia should be eliminated from the diagnosis of anorexia nervosa, and that there is a continuity of forms of extreme fasting since the late Middle Ages. A critical approach to the history of eating disorders by interpreting historical sources makes the emergence of anorexia with weight phobia in the middle of the 19th century probable. The criteria for establishing psychiatric diagnoses and the differences between historical types of extreme fasting also support the historical novelty of anorexia nervosa. The etiologic implications of the historical specificity of anorexia nervosa are limited. Research should be directed to better understand self-starvation without weight phobia. 2005 by Wiley Periodicals, Inc.

  20. Anorexia nervosa--diagnosis, aetiology, and treatment.

    Science.gov (United States)

    Hartman, D

    1995-12-01

    The aetiology, assessment and treatment of anorexia nervosa are reviewed in the light of the classical accounts of Morton, Lasègue and Gull. The core symptoms are deliberate weight loss, disturbed body image and amenorrhoea, and complications may include cardiac failure, electrolyte disturbances, hypothermia and osteoporosis. Common clinical findings are described. Disturbed brain serotonin activity is implicated in the aetiology of anorexia nervosa, but there is little support for the use of pharmacological treatments. Psychological theories of aetiology are discussed with reference to Bruch, Crisp, Palazzoli and Minuchin: the common theme is the reaction of the patient and her family to the physical and social changes of puberty. Individual and/or family psychotherapy is seen as central to the treatment of anorexia nervosa, and the relevant clinical research is reviewed. The roles of general practitioners, general psychiatrists and eating disorder specialists are discussed in the light of recent consensus treatment guidelines.

  1. Information processing bias in anorexia nervosa.

    Science.gov (United States)

    Southgate, Laura; Tchanturia, Kate; Treasure, Janet

    2008-08-15

    The aim of this study was to investigate preferential information processing style in Eating Disorders (ED). We compared the performance of participants with EDs against healthy controls in a task that measures cognitive style (reflection-impulsivity) and cognitive efficiency (inefficient-efficient). Sixty non-medicated female participants (healthy controls n=26, anorexia nervosa n=20, bulimia nervosa n=14) took part in the Matching Familiar Figures Test (MFFT), a difficult visual search paradigm with high response uncertainty. Participants with anorexia scored significantly higher on the efficiency dimension score than the control group. No significant differences were found across groups on the dimension 'reflection-impulsivity'. Participants with anorexia are more efficient (quicker response latencies in conjunction with fewer errors) in this visual search task that requires an analytic approach. This supports the hypothesis that individuals with anorexia have a positive bias toward local detail processing, indicative of weak central coherence.

  2. Nutritional adequacy of dietary intake in women with anorexia nervosa

    Science.gov (United States)

    Background: Understanding nutrient intake of anorexia nervosa (AN) patients is essential for the establishment of dietary treatment. Design: Women, aged 19 to 30 years, with both restricting and binge purge types of AN, participating in an ecological momentary assessment study, completed three nonc...

  3. Anorexia Nervosa and Bulimia: Questions and Answers for School Personnel.

    Science.gov (United States)

    Mallick, M. Joan

    1984-01-01

    School personnel can have a vital role in the early detection and treatment of anorexia nervosa and bulimia by understanding certain signs and symptoms. This article provides specific information about early detection, approaches to use when confronting the student, and methods to facilitate treatment. (Author/DF)

  4. Epidemiology and course of anorexia nervosa in the community

    NARCIS (Netherlands)

    Keski-Rahkonen, Anna; Hoek, Hans W.; Susser, Ezra S.; Linna, Milla S.; Sihvola, Elina; Raevuori, Anu; Bulik, Cynthia M.; Kaprio, Jaakko; Rissanen, Aila

    Objective: Most previous studies of the prevalence, incidence, and outcome of anorexia nervosa have been limited to cases detected through the health care system, which may bias our understanding of the disorder's incidence and natural course. The authors sought to describe the onset and outcomes of

  5. Psychosomatic syndromes and anorexia nervosa

    Directory of Open Access Journals (Sweden)

    Abbate-Daga Giovanni

    2013-01-01

    Full Text Available Abstract Background In spite of the role of some psychosomatic factors as alexithymia, mood intolerance, and somatization in both pathogenesis and maintenance of anorexia nervosa (AN, few studies have investigated the prevalence of psychosomatic syndromes in AN. The aim of this study was to use the Diagnostic Criteria for Psychosomatic Research (DCPR to assess psychosomatic syndromes in AN and to evaluate if psychosomatic syndromes could identify subgroups of AN patients. Methods 108 AN inpatients (76 AN restricting subtype, AN-R, and 32 AN binge-purging subtype, AN-BP were consecutively recruited and psychosomatic syndromes were diagnosed with the Structured Interview for DCPR. Participants were asked to complete psychometric tests: Body Shape Questionnaire, Beck Depression Inventory, Eating Disorder Inventory–2, and Temperament and Character Inventory. Data were submitted to cluster analysis. Results Illness denial (63% and alexithymia (54.6% resulted to be the most common syndromes in our sample. Cluster analysis identified three groups: moderate psychosomatic group (49%, somatization group (26%, and severe psychosomatic group (25%. The first group was mainly represented by AN-R patients reporting often only illness denial and alexithymia as DCPR syndromes. The second group showed more severe eating and depressive symptomatology and frequently DCPR syndromes of the somatization cluster. Thanatophobia DCPR syndrome was also represented in this group. The third group reported longer duration of illness and DCPR syndromes were highly represented; in particular, all patients were found to show the alexithymia DCPR syndrome. Conclusions These results highlight the need of a deep assessment of psychosomatic syndromes in AN. Psychosomatic syndromes correlated differently with both severity of eating symptomatology and duration of illness: therefore, DCPR could be effective to achieve tailored treatments.

  6. Psychosomatic syndromes and anorexia nervosa.

    Science.gov (United States)

    Abbate-Daga, Giovanni; Delsedime, Nadia; Nicotra, Barbara; Giovannone, Cristina; Marzola, Enrica; Amianto, Federico; Fassino, Secondo

    2013-01-09

    In spite of the role of some psychosomatic factors as alexithymia, mood intolerance, and somatization in both pathogenesis and maintenance of anorexia nervosa (AN), few studies have investigated the prevalence of psychosomatic syndromes in AN. The aim of this study was to use the Diagnostic Criteria for Psychosomatic Research (DCPR) to assess psychosomatic syndromes in AN and to evaluate if psychosomatic syndromes could identify subgroups of AN patients. 108 AN inpatients (76 AN restricting subtype, AN-R, and 32 AN binge-purging subtype, AN-BP) were consecutively recruited and psychosomatic syndromes were diagnosed with the Structured Interview for DCPR. Participants were asked to complete psychometric tests: Body Shape Questionnaire, Beck Depression Inventory, Eating Disorder Inventory-2, and Temperament and Character Inventory. Data were submitted to cluster analysis. Illness denial (63%) and alexithymia (54.6%) resulted to be the most common syndromes in our sample. Cluster analysis identified three groups: moderate psychosomatic group (49%), somatization group (26%), and severe psychosomatic group (25%). The first group was mainly represented by AN-R patients reporting often only illness denial and alexithymia as DCPR syndromes. The second group showed more severe eating and depressive symptomatology and frequently DCPR syndromes of the somatization cluster. Thanatophobia DCPR syndrome was also represented in this group. The third group reported longer duration of illness and DCPR syndromes were highly represented; in particular, all patients were found to show the alexithymia DCPR syndrome. These results highlight the need of a deep assessment of psychosomatic syndromes in AN. Psychosomatic syndromes correlated differently with both severity of eating symptomatology and duration of illness: therefore, DCPR could be effective to achieve tailored treatments.

  7. VIDEOFLUOROSCOPIC EVALUATION OF SWALLOWS IN ANOREXIA NERVOSA.

    Science.gov (United States)

    Santos, Carla Manfredi; Cassiani, Rachel Aguiar; Dantas, Roberto Oliveira

    2016-01-01

    There are some studies in the literature about the feeding behavior and masticatory process in patients with feeding disorders; however, it is not very well known if there are alterations in oral-pharyngeal swallowing dynamics in subjects with anorexia nervosa. To evaluate the oral and pharyngeal bolus transit in patients with anorexia nervosa. The study was conducted with 8 individuals clinically diagnosed and in treatment for restricting-type anorexia nervosa (seven women and one man), and 14 healthy individuals with no digestive or neurological symptoms (10 women, 4 men). Swallows were evaluated by videofluoroscopy with three swallows of 5 mL liquid bolus and three swallows of 5 mL paste bolus consistency, given in a random sequence. The participants were asked after each swallow about the sensation of the bolus passage. In the analysis of oral-pharyngeal transit duration, the mean duration of pharyngeal transit with paste bolus in patients with anorexia was shorter than in healthy volunteers (P=0.02). In the duration of movement of the hyoid bone, longer movement was observed in anorexia than in healthy volunteers with liquid bolus (P=0.01). With liquid bolus, five (62.5%) patients and one (7.1%) control had sensation of the bolus passage (Panorexia nervosa, although the results suggest that pharyngeal transit has shorter duration than that seen in healthy volunteers and the hyoid movement duration is longer in patients than in healthy volunteers. Fast pharyngeal transit may be the cause of bolus transit perception in patients with anorexia nervosa.

  8. Diagnostic Crossover in Anorexia Nervosa and Bulimia Nervosa: Implications for DSM-V

    Science.gov (United States)

    Eddy, Kamryn T.; Dorer, David J.; Franko, Debra L.; Tahilani, Kavita; Thompson-Brenner, Heather; Herzog, David B.

    2011-01-01

    Objective The Diagnostic and Statistical Manual of Mental Disorders (DSM) is designed primarily as a clinical tool. Yet high rates of diagnostic “crossover” among the anorexia nervosa subtypes and bulimia nervosa may reflect problems with the validity of the current diagnostic schema, thereby limiting its clinical utility. This study was designed to examine diagnostic crossover longitudinally in anorexia nervosa and bulimia nervosa to inform the validity of the DSM-IV-TR eating disorders classification system. Method A total of 216 women with a diagnosis of anorexia nervosa or bulimia nervosa were followed for 7 years; weekly eating disorder symptom data collected using the Eating Disorder Longitudinal Interval Follow-Up Examination allowed for diagnoses to be made throughout the follow-up period. Results Over 7 years, the majority of women with anorexia nervosa experienced diagnostic crossover: more than half crossed between the restricting and binge eating/purging anorexia nervosa subtypes over time; one-third crossed over to bulimia nervosa but were likely to relapse into anorexia nervosa. Women with bulimia nervosa were unlikely to cross over to anorexia nervosa. Conclusions These findings support the longitudinal distinction of anorexia nervosa and bulimia nervosa but do not support the anorexia nervosa subtyping schema. PMID:18198267

  9. Psychosurgery in the Treatment of Anorexia Nervosa

    OpenAIRE

    Franco, Silvia; Pontificia Universidad Javeriana; Otero, Óscar; Pontificia Universidad Javeriana; Acevedo González, Juan Carlos; Pontificia Universidad Javeriana; Zorro Guio, Óscar; Hospital Universitario de San Ignacio; Berbeo Calderón, Miguel; Pontificia Universidad Javeriana; Díaz Orduz, Roberto; Pontificia Universidad Javeriana; Feo Lee, Óscar; Pontificia Universidad Javeriana

    2012-01-01

    Anorexia nervosa is a severe restriction of food intake that can sometimes be associated to purging behaviour. Beyond the difficulty of manteining an addecuate body mass index, people affected by this disease suffer a constant fear of gaining weight, a severe distortion of body image, and a poor introspection of the gravity of the disease. Anorexia is associated with other commorbilities such as depression, anxiety, and personality disorders, which makes anorexia a complex disease with diffic...

  10. Shame and pride in anorexia nervosa: a qualitative descriptive study.

    Science.gov (United States)

    Skårderud, Finn

    2007-03-01

    During the last decades, there has been a rising interest in the role of shame in psychiatric disorders. To define shame and describe types and subtypes of shame and their relations to symptoms and meaning in anorexia nervosa. The study will also describe the possible role of pride, as a contrasting emotional and cognitive experience. Thirteen female patients (age 16-39 years) with anorexia nervosa were interviewed about their general understanding of the concept of shame, what they considered shameful in themselves, past and present, and in others and shame related to eating and body. Based on statements from the patients 'globalised internal shame', different subtypes of focal shame and different subtypes of pride are categorised. Shame is described both as cause and consequence in relation to symptoms in anorexia nervosa, hence a shame-shame cycle. A shame-pride cycle is also presented. The use of shame, as well as pride, as concepts in regard to anorexia nervosa may improve our understanding of the nature of this disorder, as well as being a guideline for therapists. 2007 John Wiley & Sons, Ltd and Eating Disorders Association

  11. Biomarkører for anorexia nervosa

    DEFF Research Database (Denmark)

    Sjögren, Magnus

    2017-01-01

    Biomarkers for anorexia nervosa (AN) which reflect the pathophysiology and relate to the aetiology of the disease, are warranted and could bring us one step closer to targeted treatment of AN. Some leads may be found in the biochemistry which often is found disturbed in AN, although normalization...

  12. Anorexia Nervosa: Its Symptoms and Possible Cures.

    Science.gov (United States)

    Bingaman, David E.

    This document presents a definition and description of anorexia nervosa as a disorder that occurs predominantly in girls and that can affect 1 out of every 250 girls between the ages of 12 and 18 years. The existence of a distorted mental body image among anorexics is discussed and symptoms of the disorder are described, including amenorrhea…

  13. Body representation disturbances in anorexia nervosa

    NARCIS (Netherlands)

    Keizer, A.

    2014-01-01

    One of the main symptoms of anorexia nervosa (AN) is a disturbed experience of body size and shape. Although patients are underweight, they experience their body as bigger than it in reality is. Previous studies were mainly conducted by (clinical) psychologists and psychiatrists, and almost

  14. Update on endocrine disturbances in anorexia nervosa

    DEFF Research Database (Denmark)

    Støving, R K; Hangaard, J; Hagen, C

    2001-01-01

    The marked endocrine changes that occur in anorexia nervosa have aroused a great deal of interest, and over the last decade much research has been conducted in this field. The endocrine disturbances are not specific to this disorder, as they also occur in starvation states secondary to other causes...

  15. Anorexia Nervosa--A Teacher's Perspective.

    Science.gov (United States)

    Rittner, Max

    The paper describes the physical and psychological symptoms of anorexia nervosa, treatment methods, and implications for the classroom. A rationale is offered for the predominance of upper-middle and upper class female adolescents in the anorectic population. Four models of treatment for the anorectic individual are considered: medical,…

  16. Dronabinol in severe, enduring anorexia nervosa

    DEFF Research Database (Denmark)

    Andries, Alin; Frystyk, Jan; Flyvbjerg, Allan

    2014-01-01

    The evidence for pharmacological treatment of severe, longstanding anorexia nervosa (AN) is sparse and the few controlled pharmacologic studies have focused on a narrow range of drugs. The aim of the present study was to investigate the effects of treatment with a synthetic cannabinoid agonist...

  17. Compulsory Treatment in Anorexia Nervosa : A Review

    NARCIS (Netherlands)

    Elzakkers, Isis F. F. M.; Danner, Unna N.; Hoek, Hans W.; Schmidt, Ulrike; van Elburg, Annemarie A.

    2014-01-01

    ObjectiveCompulsory in-patient refeeding of patients with severe anorexia nervosa (AN) has caused considerable controversy. The effects of such treatment on longer-term outcome are not well known. The objective of this article is to review the evidence on the outcome of compulsory treatment for AN.

  18. Compulsory treatment in anorexia nervosa : A review

    NARCIS (Netherlands)

    Elzakkers, Isis F F M; Danner, Unna N; Hoek, Hans W; Schmidt, Ulrike; van Elburg, Annemarie A|info:eu-repo/dai/nl/191430129

    2014-01-01

    OBJECTIVE: Compulsory in-patient refeeding of patients with severe anorexia nervosa (AN) has caused considerable controversy. The effects of such treatment on longer-term outcome are not well known. The objective of this article is to review the evidence on the outcome of compulsory treatment for

  19. Behavioral neuroendocrinology and treatment of anorexia nervosa

    NARCIS (Netherlands)

    Sodersten, P.; Nergardh, R.; Bergh, C.; Zandian, M.; Scheurink, A.

    2008-01-01

    Outcome in anorexia nervosa remains poor and a new way of looking at this condition is therefore needed. To this aim, we review the effects of food restriction and starvation in humans. It is suggested that body weight remains stable and relatively low when the access to food requires a considerable

  20. Anorexia Nervosa in Chinese Adolescents: Does Culture Make a Difference?

    Science.gov (United States)

    Lai, Kelly Y. C.

    2000-01-01

    Reports on clinical and psychosocial characteristics of 16 Chinese adolescents from Hong Kong with anorexia nervosa. Over 80% of these patients expressed a fear of fatness. Against the background of increasing Westernization of Hong Kong society, anorexia is taking on a Western pattern, in congruence with the notion that anorexia nervosa is a…

  1. [Long-term course of anorexia nervosa].

    Science.gov (United States)

    Willi, J; Hagemann, R

    1976-10-23

    A follow-up study has been recently conducted in 20 female patients with severe anorexia nervosa who had undergone stationary psychotherapeutic treatment at our clinic 8-16 years ago. Whilst according to our findings the prognosis for anorexia nervosa still remains poor, it does not seem quite so hopeless as is frequently presumed. Out of the 20 patients followed up, 5 now have chronic anorexia nervosa and in 2 cases transition to an endogenous psychosis has occurred (schizophrenia simplex with chronified anorexia in one, and endogenous depression after improvement of anorexia in the other case). 1 patient died in the interval between observations as a result of her anorexia. The general results of our investigation roughly confirm the rule-of-thumb predictions for many psychotherapeutic treatments of neurotic diseases, i.e. 1/3 unimproved, 1/3 improved, 1/3 cured. Although free from illness, the majority of the patients must be described as conspicuous within the norm. The typical personal characteristics of the anorectic are maintained, their weight remains below normal level, and they suffer from eating problems. According to our investigation a positive prognosis correlates with onset of the illness before the age of 18, absence of laxative abuse, and subsequent marriage, whereas premature interruption of the treatment with return to the parental home proves to have a negative effect. In apparent contradiction to the persistence of the characteristic anorectic features is the evidence that out of the 20 patients in question 12 married and 8 had children. On the other hand, the fact that during the interval between observations 4 patients relapsed into severe anorexia in connexion with engagement or pregnancy indicates that acceptance of a mature female or maternal role often remains a problem. Of gynecologic interest is the fact that long-lasting secondary amenorrhea (up to 10 years, with an average of 5 years) has not led to fertility problems for any of the

  2. Dysthymia in anorexia nervosa and bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Mercedes Borda-Más

    2008-01-01

    Full Text Available Este estudio ex post facto analiza la presencia de distimia en 155 mujeres. Noventa y tres pacientes cumplían los criterios diagnósticos para un trastorno de la conducta alimentaria (TCA: 31 con anorexia nerviosa restrictiva (ANr, 31 con anorexia nerviosa purgativa/bulímica (ANp y 31 con bulimia nerviosa purgativa (BNp; y 62 mujeres constituían los dos grupos comparativos: 31 con alto riesgo de padecer un TCA (grupo comparativo sintomático: GC-S y 31 sin patología conocida (grupo comparativo no sintomático: GC-NS. Todas ellas cumplimentaron la versión española del MCMI-II. En los resultados encontramos diferencias significativas en las medias obtenidas por los grupos con TCA respecto a los dos grupos comparativos, y que presentaban el posible síndrome distímico [puntuaciones Tasa Base (TB > 74] el 50% de las pacientes con ANr, el 60% con ANp y el 63,30% de las pacientes con BNp. Sólo el 16,70% de las mujeres de alto riesgo y el 5,70% de las mujeres sin patología lo presentaban. Estos hallazgos indican que el síndrome distímico es frecuente en las mujeres con TCA, y en aquellas que presentan conductas purgativas aumenta levemente la severidad del mismo.

  3. Study Protocol: Using Deep-Brain Stimulation, Multimodal Neuroimaging and Neuroethics to Understand and Treat Severe Enduring Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Rebecca J. Park

    2018-04-01

    Full Text Available BackgroundResearch suggests that altered eating and the pursuit of thinness in anorexia nervosa (AN are, in part, a consequence of aberrant reward circuitry. The neural circuits involved in reward processing and compulsivity overlap significantly, and this has been suggested as a transdiagnostic factor underpinning obsessive compulsive disorder, addictions and eating disorders. The nucleus accumbens (NAcc is central to both reward processing and compulsivity. In previous studies, deep-brain stimulation (DBS to the NAcc has been shown to result in neural and symptomatic improvement in both obsessive compulsive disorder and addictions. Moreover, in rats, DBS to the NAcc medial shell increases food intake. We hypothesise that this treatment may be of benefit in severe and enduring anorexia nervosa (SE-AN, but first, feasibility and ethical standards need to be established. The aims of this study are as follows: (1 to provide feasibility and preliminary efficacy data on DBS to the NAcc as a treatment for SE-AN; (2 to assess any subsequent neural changes and (3 to develop a neuroethical gold standard to guide applications of this treatment.MethodThis is a longitudinal study of six individuals with SE-AN of >7 years. It includes an integrated neuroethical sub-study. DBS will be applied to the NAcc and we will track the mechanisms underpinning AN using magnetoelectroencephalography, neuropsychological and behavioural measures. Serial measures will be taken on each intensively studied patient, pre- and post-DBS system insertion. This will allow elucidation of the processes involved in symptomatic change over a 15-month period, which includes a double-blind crossover phase of stimulator on/off.DiscussionNovel, empirical treatments for SE-AN are urgently required due to high morbidity and mortality costs. If feasible and effective, DBS to the NAcc could be game-changing in the management of this condition. A neuroethical gold standard is crucial to

  4. Effectiveness of psychopharmacology in Anorexia Nervosa treatment

    Directory of Open Access Journals (Sweden)

    Zadka Lukasz

    2015-06-01

    Full Text Available The eating disorder that generates the highest death rate is that of anorexia nervosa, and current treatment is a combination of equalization of somatic state and patient education. Moreover, psychical symptoms occurring in the course of anorexia nervosa are thought to have a crucial influence on the course of the disease. Hence, in medical literature, the effectiveness of psychotherapeutic interventions is also widely described. Still, the implementation of appropriate psychopharmacology is now considered an additional method of treatment, rather than a therapy of choice. Yet, in spite of many years of research, there are no absolute recommendations given, nor are instructions within the scope of psychopharmacological treatment proffered, although the selection of psychopharmacological items must respect both the patient’s psychic and somatic states. In recent years, the popularity of psychopharmacological treatment has increased; therefore, we feel that it is justified to present the latest scientific information in this respect.

  5. [Anorexia nervosa - a familial socialization deficit].

    Science.gov (United States)

    Gensicke, P

    1979-01-01

    This study is based on the hypothesis that there is a connexion between the condition of Anorexia nervosa and factors of family socialization. The empirical examination of this assumption was carried out using the hospital records of 51 female patients treated for Anorexia nervosa in the Psychiatric University Hospital Göttingen from the period of 1967 to 1973. The family structure was investigated under the following context: 1) family constellation, 2) socioeconomic factors, 3) interactional patterns. At first sight these families have a normally disturbuted family constellation, a stable and accepted social status together with traditional social values. However, disturbed parental and matrimonial relationships in fluence the family attitudes in such a way as to enhance these behavior patterns associated with high performance and pseudo-solidarity. This complex family structure effects the anorexic patients such that--in an interactional view--an inbalance of ego identity arises and a adolescence crisis occurs.

  6. The Life with Anorexia and Bulimia Nervosa

    OpenAIRE

    Licková, Gabriela

    2008-01-01

    The Life with Anorexia and Bulimia Nervosa The Bachelor's thesis deals with problems of eating disordes. This work is focused on the manifestations of the illness and feelings of the women who are suffering from this disorder. The research part of the thesis is focused on the means the women use for fighting with this illness, how they deal with it and what helps them to manage the manifestations of the illness.

  7. Involuntary admission: the case of anorexia nervosa.

    Science.gov (United States)

    Douzenis, Athanasios; Michopoulos, Ioannis

    2015-01-01

    Involuntary treatment of psychiatric disorders has always been controversial; this is especially true for eating disorders. Patients with anorexia nervosa of life threatening severity frequently refuse psychiatric hospitalization. Ambivalence toward treatment is characteristic of eating disorders and patients are often admitted to inpatient programs under pressure from family and doctors. In this article, we report research on the positive or negative impact of involuntary admission in the treatment of eating disorders, its application and effectiveness as well as the adverse consequences of coercive treatment in eating disorders. A literature review was done. From a total of 134 publications which were retrieved from the literature search, 50 studies were directly relevant to the scope of this review and fulfilled all inclusion criteria. There are trends and arguments for both sides; for and against involuntary treatment in anorexia nervosa. The scientific literature so far is inconclusive, although in the short term, involuntary hospitalization has benefits. This review has also shown that involuntary hospitalization can have adverse long-term consequences for the patient-therapist allegiance. We conclude that in some cases, involuntary treatment can save lives of young patients with anorexia nervosa; however, in other cases, it can break the psychotherapeutic relationship and make the patient abandon treatment. It is the clinician who has to decide for whom and when to approve involuntary treatment or not. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Anorexia nervosa e gravidez: relato de caso Anorexia nervosa and pregnancy: a case report

    OpenAIRE

    Fabiano Gonçalves Nery; Antônio Lúcio Teixeira-Jr; Gislene Valadares Miranda; Maurício Viotti Daker

    2002-01-01

    Relata-se o caso de uma adolescente de 18 anos que desenvolveu quadro de hiperemese gravídica seguida de anorexia nervosa durante sua primeira gravidez, chegando a índice de massa corporal (IMC) de 14,3 Kg/m². Os sintomas apresentados remitiram após o término prematuro da gestação. Apesar de a anorexia nervosa ser incomum na gravidez, seu diagnóstico é importante em virtude dos riscos para a saúde materna e fetal.The authors describe a case of an eighteen years-old adolescent who developed hy...

  9. Perspectives on the Prevention of Anorexia Nervosa and Bulimia

    OpenAIRE

    Steiger, Howard; Leichner, Pierre; Ghadirian, A. Missagh

    1987-01-01

    Ample evidence suggests a rising incidence of anorexia nervosa and bulimia over the past few decades. Correspondingly, medical knowledge about the etiology, symptomatology and treatment of these eating disorders has increased. Often the front line health-care workers who treat these disorders, family physicians are in a key position for early detection and prevention of these eating disorders. An adequate understanding of relevant risk factors, symptoms and signs may allow the physician to pr...

  10. Saccadic Eye Movements in Anorexia Nervosa.

    Directory of Open Access Journals (Sweden)

    Andrea Phillipou

    Full Text Available Anorexia Nervosa (AN has a mortality rate among the highest of any mental illness, though the factors involved in the condition remain unclear. Recently, the potential neurobiological underpinnings of the condition have become of increasing interest. Saccadic eye movement tasks have proven useful in our understanding of the neurobiology of some other psychiatric illnesses as they utilise known brain regions, but to date have not been examined in AN. The aim of this study was to investigate whether individuals with AN differ from healthy individuals in performance on a range of saccadic eye movements tasks.24 females with AN and 25 healthy individuals matched for age, gender and premorbid intelligence participated in the study. Participants were required to undergo memory-guided and self-paced saccade tasks, and an interleaved prosaccade/antisaccade/no-go saccade task while undergoing functional magnetic resonance imaging (fMRI.AN participants were found to make prosaccades of significantly shorter latency than healthy controls. AN participants also made an increased number of inhibitory errors on the memory-guided saccade task. Groups did not significantly differ in antisaccade, no-go saccade or self-paced saccade performance, or fMRI findings.The results suggest a potential role of GABA in the superior colliculus in the psychopathology of AN.

  11. [Anorexia nervosa - from a neuroscience perspective].

    Science.gov (United States)

    Kappel, Viola; van Noort, Betteke; Ritschel, Franziska; Seidel, Maria; Ehrlich, Stefan

    2014-01-01

    Anorexia nervosa is a frequent disorder especially among adolescent girls and young women, with high morbidity, mortality, and relapse rates. To date, no single therapeutic approach has proved to be superior to others (Herpertz et al., 2011). It remains unclear how its etiology and pathology are encoded within cognitive, neural, and endocrinological processes that modulate important mechanisms in appetitive processing and weight regulation. Yet, several trait characteristics have been identified in AN which might reflect predisposing factors. Further, altered levels of neuropeptides and hormones that regulate appetite and feeding behavior have been found during both the acute and the recovered state, pointing to dysfunctional mechanisms in AN that persist even after malnutrition has ceased. Researchers are also hoping that brain imaging techniques will allow for a more detailed investigation of the neural basis of reward and punishment sensitivity that appears to be altered in AN. The integration and extension of recent findings in these areas will hopefully provide a more comprehensive understanding of the disorder and hence enable the development of more effective treatments.

  12. The Disjointed Historical Trajectory of Anorexia Nervosa Before 1970.

    Science.gov (United States)

    Court, John P M; Kaplan, Allan S

    2016-01-01

    Responses in pre-modern eras to anorexia nervosa (as now understood) varied widely, from religious piety and sanctity through fear and superstition. While noting briefly the limited conceptualizations from pre-modern history this article is primarily focused from the late 19th century, commencing with helpful but tentative formulations of anorexia nervosa for early-modern medicine that were laid out, consistently between themselves, by Lesègue, Gull and Osler. Yet that promising biomedical advent was superseded for more than a half-century by deep, internal divisions and bitter rifts that festered between three medical disciplines: neurology; Freudian psychotherapy; and Kraepelinian biological psychiatry. Mid-20th century developments preceded the 1960-1980s' improved understanding of suffering and movement toward effective remediation introduced by Dr. Hilde Bruch.

  13. Hippocampal volume and cognitive function in anorexia nervosa.

    Science.gov (United States)

    Connan, Frances; Murphy, Fay; Connor, Steve E J; Rich, Phil; Murphy, Tara; Bara-Carill, Nuria; Landau, Sabine; Krljes, Sanya; Ng, Virginia; Williams, Steve; Morris, Robin G; Campbell, Iain C; Treasure, Janet

    2006-03-31

    We hypothesised that hippocampal volume would be reduced in underweight anorexia nervosa (AN) and associated with impaired hippocampus-dependent cognitive function. Hippocampal and whole brain volumes were measured in 16 women with AN and 16 matched healthy women using magnetic resonance imaging (MRI) and a manual tracing method. Participants also completed the Doors and People Test of hippocampus-dependent memory and an IQ test. After adjustment for total cerebral volume, there was significant bilateral reduction in hippocampal volume in the AN group (8.2% right; 7.5% left). There was no evidence of impaired hippocampus-dependent cognitive function and no evidence of a relationship between hippocampal volume and clinical features of AN. The reduced hippocampal volume in anorexia nervosa is not associated with changes in cognitive function. To understand the cause and consequence of hippocampal size and function, it will be important to integrate endocrine, neuropsychological and neuroimaging studies.

  14. Binge eating as a meaningful experience in bulimia nervosa and anorexia nervosa: a qualitative analysis.

    Science.gov (United States)

    Eli, Karin

    2015-12-01

    Clinical studies describe binge eating as a reaction to hunger, negative affect, or the need to dissociate. However, little is known about the meanings that women with bulimia nervosa and anorexia nervosa associate with binge eating. To examine how women with anorexia nervosa and bulimia nervosa interpret their experiences of binge eating. Sixteen women who engaged in binge eating and had been diagnosed with anorexia nervosa, bulimia nervosa, or their subclinical variants were interviewed about their experiences of eating disorder. Interview data were analyzed using phenomenologically-informed thematic analysis. Participants described binge eating as a practice through which the self experiences a sense of release, and existential emptiness is replaced by overwhelming fullness. Meaningful experiences of release and fullness are central to binge eating in bulimia nervosa and anorexia nervosa, and may contribute to the long-term maintenance of this practice.

  15. The CT appearance of ''reversible'' cerebral pseudoatrophy in anorexia nervosa

    International Nuclear Information System (INIS)

    Boron, Z.; Kozlowska, R.; Grzegorzewski, M.; Nawrot, M.; Bulawska, I.

    1995-01-01

    The CT appearance of ''reversible'' cerebral pseudoatrophy resulting from anorexia nervosa was demonstrated. The CT studies were performed in 3 young women with typical clinical course of anorexia nervosa. In all of them computed tomography revealed dilatation of the subarachnoid fluid space. After 5 months of therapy the follow-up scans have reverted to normal in all cases. (author)

  16. Multimodal Therapy for Anorexia Nervosa: An Holistic Approach to Treatment.

    Science.gov (United States)

    O'Keefe, Edward J.; Castaldo, Christine

    1985-01-01

    Anorexia nervosa has received considerable attention lately because of its increased incidence, potential danger, and resistance to treatment. A review of the literature on anorexia nervosa suggests that, although it is characterized by complex interrelated psychological and physiological processes, it is often conceptualized and treated in…

  17. Symptoms, Causes and Possible Treatment of Anorexia Nervosa.

    Science.gov (United States)

    Odebunmi, Akin

    This document provides research findings, a discussion of etiology, case studies, and treatment approaches for anorexia nervosa. The research findings classify the anorexic patient by sex, age, presenting characteristics, socioeconomic status, premorbid personality, and cultural and familial characteristics. The etiology of anorexia nervosa is…

  18. Special Issue: Outcome of Anorexia Nervosa with Teenage Onset.

    Science.gov (United States)

    Casper, Regina C., Ed.

    1996-01-01

    The articles of this special issue report on studies of the outcomes of treatment of adolescent anorexia nervosa. These studies leave no doubt about the mortality risk and debilitating nature of chronic anorexia nervosa, but they do suggest that the prognosis, given expert treatment, is favorable for the most part. (SLD)

  19. Anorexia nervosa: an increasing problem in children and adolescents

    OpenAIRE

    Halmi, Katherine A.

    2009-01-01

    Information from eating disorder clinics across five continents suggests that anorexia nervosa is becoming an increasing problem in children and young adolescents. There is some indication that anxiety disorders in childhood may be a major risk factor for the development of anorexia nervosa. Early recognition and family treatment for this disorder are essential to prevent chronic impairment.

  20. Anorexia Nervosa: A Misdiagnosis of the Adolescent Male.

    Science.gov (United States)

    Svec, Henry

    1987-01-01

    Discusses rarity of anorexia nervosa among male population with primary reference to differences from female symptomatology. Presents case which implies that anorexia nervosa in the male may be a marker for other more severe pathology. Presents findings which suggest a diagnostic strategy based on familial, behavioral, environmental, educational,…

  1. Anorexia nervosa e gravidez: relato de caso Anorexia nervosa and pregnancy: a case report

    Directory of Open Access Journals (Sweden)

    Fabiano Gonçalves Nery

    2002-02-01

    Full Text Available Relata-se o caso de uma adolescente de 18 anos que desenvolveu quadro de hiperemese gravídica seguida de anorexia nervosa durante sua primeira gravidez, chegando a índice de massa corporal (IMC de 14,3 Kg/m². Os sintomas apresentados remitiram após o término prematuro da gestação. Apesar de a anorexia nervosa ser incomum na gravidez, seu diagnóstico é importante em virtude dos riscos para a saúde materna e fetal.The authors describe a case of an eighteen years-old adolescent who developed hyperemesis gravidarum followed by anorexia nervosa during her first pregnancy. Her body mass index (BMI achieved 14.3 Kg/m². The symptoms remitted after the premature delivery of the newborn. Although anorexia nervosa is uncommon in pregnancy, its diagnosis is important in view of the risks for the health of mother and fetus.

  2. Adolescents with anorexia nervosa have their say: a review of qualitative studies on treatment and recovery from anorexia nervosa.

    Science.gov (United States)

    Bezance, Jessica; Holliday, Joanna

    2013-09-01

    Anorexia nervosa often begins in adolescence, and there is a growing body of quantitative literature looking at the efficacy of treatment for adolescents. However, qualitative research has a valuable contribution to make to the understanding of treatment and recovery. This paper aims to review qualitative studies on the experience of treatment and recovery for adolescents with anorexia nervosa. Key themes from the 11 studies identified the role of family, peers and professionals, family therapy, the inpatient setting, emphasis on physical versus psychological and conceptualisation of recovery. Future studies would benefit from relating their findings to adolescent theory and considering reflexivity. Implications for clinical practice are also discussed. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

  3. Review of Liebman et al.'s 'An integrated treatment program for anorexia nervosa'.

    Science.gov (United States)

    Wright, Shelagh

    2006-07-01

    This article reviews the paper by Liebman, Minuchin, and Baker (1974) describing the use of a family meal as part of an integrated treatment approach for anorexia nervosa. The ideas laid out in the paper are described and discussed in terms of the understanding of anorexia nervosa at the time as well as placed in a current clinical and theoretical context. A comment is made on whether or not, in this author's opinion, the paper stands 'the test of time'.

  4. Outcome, comorbidity and prognosis in anorexia nervosa.

    Science.gov (United States)

    Jagielska, Gabriela; Kacperska, Iwona

    2017-04-30

    Anorexia nervosa (AN) is a relatively common disorder, especially in adolescent and young adult women. The lifetime prevalence of AN in females ranges from 1.2 to 2.2%. The prevalence in males is 10-times lower. The condition is associated with a high risk of chronic course and poor prognosis in terms of treatment and the risk of death. Longer follow-up periods seemed to correspond with increased improvement rates and increased mortality. Onset of the disorder during adolescence is associated with better prognosis. It is reported that as much as 70% to over 80% of patients in this age group achieve remission. Worse outcomes are observed in patients who required hospitalization and in adults. Recent studies indicate improved prognosis for cure and lower mortality rates than previously reported. However, the recovery can take several years and AN is associated with high risk of developing other psychiatric disorders during the patients' lifetime, even after recovery from AN (mainly: affective disorders, anxiety disorders, obsessive-compulsive disorders, substance abuse disorders). Studies indicate that bulimic symptoms often occur in the course of anorexia nervosa (especially within 2-3 years from the onset of AN). The authors present a review of literature on the course, comorbidity, mortality, and prognostic factors in AN. Better knowledge of the course of anorexia can contribute to more realistic expectations of the pace of symptomatic improvement, as well as to a creation of therapeutic programs which are better adapted to the needs of the patients.

  5. Anorexia nervosa: uma revisão

    Directory of Open Access Journals (Sweden)

    Eder Schmidt

    2008-12-01

    Full Text Available Os autores apresentam uma revisão de alguns pontos de vista com relação à anorexia nervosa. Alinham-se aspectos classificatórios, históricos, clínicos e terapêuticos. Reconhecida como a base para ocorrências místicas na Idade Média, foi entendida como uma apresentação histérica no século XVII, para tornar-se, logo em seguida, objeto das indagações freudianas. Discute-se a anorexia como uma apresentação da estrutura histérica, aqui abordada a partir dos conceitos freudianos sobre histeria, Édipo e feminino, e considerando-se o corpo físico como um mero suporte para articulações simbólicas. Para Freud, a anorexia nervosa seria um quadro pelo qual a histérica exprime sua aversão à sexualidade.

  6. Anorexia nervosa and bulimia nervosa: brains, bones and breeding.

    Science.gov (United States)

    Starr, Taylor B; Kreipe, Richard E

    2014-05-01

    Recent research has modified both the conceptualization and treatment of eating disorders. New diagnostic criteria reducing the "not otherwise specified" category should facilitate the early recognition and treatment of anorexia nervosa (AN) and bulimia nervosa (BN). Technology-based studies identify AN and BN as "brain circuit" disorders; epidemiologic studies reveal that the narrow racial, ethnic and income profile of individuals no longer holds true for AN. The major organs affected long term-the brain and skeletal system-both respond to improved nutrition, with maintenance of body weight the best predictor of recovery. Twin studies have revealed gene x environment interactions, including both the external (social) and internal (pubertal) environments of boys and of girls. Family-based treatment has the best evidence base for effectiveness for younger patients. Medication plays a limited role in AN, but a major role in BN. Across diagnoses, the most important medicine is food.

  7. Young Women With Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Elisabeth Dahlborg Lyckhage

    2015-03-01

    Full Text Available The aim of this study was to describe how young women living with self-identified anorexia narrate about their lives by blogging. Thirteen Swedish blogs were chosen and analyzed by means of qualitative content analysis. The results described falling ill, the illness itself, and the path to recovery. Low self-esteem, depressed state of mind, and self-destructive behavior were typical signs at the start of the illness. The women’s lives were characterized by a need for controlling their body by tormenting it and by the illness demanding all their concentration and energy. The women suffered from the feeling of being a disappointment to their family members. The illness was like an enemy that had to be defeated with the help of family members, health care professionals, and by means of therapy. A turning point occurred when the women felt at their worst or had tired of the illness and could concentrate on something other than their body and the eating disorder. Suffering from self-identified anorexia was described as experiencing low self-esteem. The illness took all of the women’s time and energy. For a turning point to be reached, the women needed support from family, friends, and health care professionals, including the use of distractions.

  8. An Integrative Bio-Psycho-Social Theory of Anorexia Nervosa.

    Science.gov (United States)

    Munro, Calum; Randell, Louise; Lawrie, Stephen M

    2017-01-01

    The need for novel approaches to understanding and treating anorexia nervosa (AN) is well recognized. The aim of this paper is to describe an integrative bio-psycho-social theory of maintaining factors in AN. We took a triangulation approach to develop a clinically relevant theory with face validity and internal consistency. We developed theoretical ideas from our clinical practice and reviewed theoretical ideas within the eating disorders and wider bio-psycho-social literature. The synthesis of these ideas and concepts into a clinically meaningful framework is described here. We suggest eight key factors central to understanding the maintenance and treatment resistance of anorexia nervosa: genetic or experiential predisposing factors; dysfunctional feelings processing and regulation systems; excessive vulnerable feelings; 'feared self' beliefs; starvation as a maladaptive physiological feelings regulation mechanism; maladaptive psychological coping modes; maladaptive social behaviour; and unmet physical and psychological core needs. Each of these factors serves to maintain the disorder. The concept of universal physical and psychological core needs can provide an underpinning integrative framework for working with this distinctly physical and psychological disorder. This framework could be used within any treatment model. We suggest that treatments which help address the profound lack of trust, emotional security and self-acceptance in this patient group will in turn address unmet needs and improve well-being. Copyright © 2016 John Wiley & Sons, Ltd. The concept of unmet physical and psychological needs can be used as an underlying integrative framework for understanding and working with this patient group, alongside any treatment model. A functional understanding of the neuro-biological, physiological and psychological mechanisms involved in anorexia nervosa can help patients reduce self-criticism and shame. Fears about being or becoming fat, greedy, needy

  9. Eating one's words, part II: The embodied mind and reflective function in anorexia nervosa--theory.

    Science.gov (United States)

    Skårderud, Finn

    2007-07-01

    Anorexia nervosa as a psychiatric disorder presents itself through the concreteness of symptoms. Emotions are experienced as a corporeality here-and-now. In a companion article, Part I, different 'body metaphors' are described and categorised. The human body functions as metaphor, and in anorexia nervosa there is a striking closeness between emotions and different bodily experiences. This is interpreted as impaired 'reflective function', referring to the capacity to make mental representations, and is proposed as a central psychopathological feature. The psychodynamic concepts 'concretised metaphors' and 'psychic equivalence' are discussed as useful tools to better understand such compromised symbolic capacity. Psychotherapy in anorexia nervosa can be described as a relational process where concretised metaphors will be developed into genuine linguistic ones. Part III in this series of articles presents an outline for psychotherapy for anorexia nervosa. 2007 John Wiley & Sons, Ltd and Eating Disorders Association

  10. The occupational roles of women with anorexia nervosa Los papeles ocupacionales de mujeres con anorexia nervosa Os papéis ocupacionais de mulheres com anorexia nervosa

    Directory of Open Access Journals (Sweden)

    Leila Maria Quiles-Cestari

    2012-04-01

    Full Text Available This study’s objective was to understand how occupational roles of individuals with anorexia nervosa are configured. The sample was composed of a control group and 11 adult women with anorexia nervosa being cared for by the Eating Disorders Care Group in a hospital in Ribeirão Preto, SP, Brazil. Socio-demographic and anthropometric data were collected and the Role Checklist was applied. The results revealed a significant loss of roles for women with anorexia nervosa in relation to the performance of the roles worker, friend, and amateur/hobbyist, supporting the idea that psychosocial harm may arise from this eating disorder. The evaluation of occupational roles in the treatment of eating disorders is an important strategy for planning Occupational Therapy activities and supporting the creation of healthier spaces to enable individuals to resume occupational roles, and acquire independence and autonomy.El objetivo es entender como figuran los papeles ocupacionales de las personas con anorexia nervosa. La casuística fue compuesta por 11 personas diagnosticadas en tratamiento en el Grupo de Asistencia en Trastornos Alimentares de un Hospital de Ribeirão Preto-Brasil y un grupo control. Se recogieron variables sociodemográficas, antropométricas y por la “Lista de Identificación de Papeles Ocupacionales”. Los resultados muestran hubo cambio, con pérdida de papeles debido a la anorexia nerviosa, con pérdida de los papeles de trabajador, voluntario, amigo y pasatiempo amador, corroborando los perjuicios psicosociales derivados de este trastorno. La evaluación de los papeles ocupacionales en el tratamiento de los trastornos alimentares es una estrategia importante para la planificación de la terapia ocupacional por la concesión de subvenciones para crear ambientes más saludables, donde las posibilidades de crear el rescate de los papeles ocupacionales, la independencia y autonomía.O objetivo desta pesquisa foi compreender como se

  11. Sexual function of women suffering from anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Gonidakis, Fragiskos; Kravvariti, Vasilliki; Varsou, Eleftheria

    2015-01-01

    The cross-sectional study aimed at examining the sexual function of young adult women suffering from eating disorders. The authors interviewed 53 women (26 with anorexia nervosa and 27 with bulimia nervosa) and 58 female students. Each participant was administered the Female Sexual Function Index, the Eating Attitudes Test, the Body Shape Questionnaire, and the Beck Depression Inventory. Comparisons among the 3 groups showed that patients with anorexia nervosa scored lower in each Female Sexual Function Index subscale than did healthy controls. There was no significant difference between bulimia nervosa and healthy controls. Sexual functionality of patients with anorexia nervosa was correlated only with body mass index (r = 0.5, p =.01). Sexual functionality of patients with bulimia nervosa was correlated only with the Beck Depression Inventory (r = -0.4, p =.03) Patients with anorexia nervosa had more disturbed sexual function than did controls. Sexual function can be related to the level of starvation and symptoms of depression.

  12. [Anorexia nervosa: study method and sleep analysis].

    Science.gov (United States)

    Cervera, S; Zapata, R; Gual, P; Quintanilla, B

    1989-01-01

    By studying anorexia nervosa with an Integrated Inventory and the quality and the quantity of sleep applying Hauri's scale for the analysis of dream contents, the sleeping habits of 50 anorexic patients who were under treatment have been studied. The results show that sleep in these patients is similar and sometimes better in quantity and quality than those in the control group. Their dreams are characterized by an almost total absence of sexual, aggressive and alimentary contents, and that reality, active participation, unpleasant feelings and sensory-perceptive elements are predominant.

  13. The impact of hyperactivity and leptin on recovery from anorexia nervosa

    NARCIS (Netherlands)

    Elburg, A.A. van; Kas, M.J.H.; Hillebrand, J.J.G.; Eijkemans, R.J.C.; Engeland, H. van

    2007-01-01

    In anorexia nervosa (AN), hyperactivity is observed in about 80% of patients and has been associated with low leptin levels in the acute stage of AN and in anorexia animal models. To further understand the importance of this correlation in AN, we investigated the relationship between

  14. Altered social reward and attention in anorexia nervosa

    Directory of Open Access Journals (Sweden)

    Karli K Watson

    2010-09-01

    Full Text Available Dysfunctional social reward and social orienting attend a variety of neuropsychiatric disorders including autism, schizophrenia, social anxiety, and psychopathy. Here we show that similar social reward and attention dysfunction attend anorexia nervosa, a disorder defined by avoidance of food and extreme weight loss. We measured the implicit reward value of social stimuli for female participants with (n=11 and without (n=11 anorexia nervosa using an econometric choice task and also tracked gaze patterns during free viewing of images of female faces and bodies. As predicted, the reward value of viewing bodies varied inversely with observed body weight for women with anorexia but not neurotypical women, in contrast with their explicit ratings of attractiveness. Surprisingly, women with anorexia nervosa, unlike neurotypical women, did not find female faces rewarding and avoided looking at both the face and eyes—independent of observed body weight. These findings demonstrate comorbid dysfunction in the neural circuits mediating gustatory and social reward in anorexia nervosa.

  15. Schizophrenia and anorexia nervosa - reciprocal relationships. A literature review.

    Science.gov (United States)

    Morylowska-Topolska, Justyna; Ziemiński, Rafał; Molas, Agnieszka; Gajewski, Jacek; Flis, Marta; Stelmach, Ewa; Karakuła-Juchnowicz, Hanna

    2017-04-30

    Although schizophrenia and anorexia nervosa are seemingly very distinct psychiatric disorders, their symptoms are connected by various types of relationships. The present article reviews the literature and recapitulates the views of various authors on the links between these two disorders. Symptoms of anorexia may 1) precede the onset of psychosis; 2) evolve in its active phase or more rarely manifest in remission; and, conversely, 3) psychotic symptoms may occur transiently in the course of anorexia nervosa. When anorexia precedes the manifestation of psychosis, symptoms of anorexia can be treated as a component of the prodromal phase of schizophrenia. Another possibility of co-existence of a psychosis (e.g., schizophrenia) with anorexia is when the eating disorder syndrome manifests at the same time as the full-blown psychotic syndrome. In such cases, when the symptoms of the two disorders occur simultaneously, it is often difficult to say whether the patient is suffering from schizophrenia, in the course of which anorexia has arisen secondary to psychotic symptoms or whether he/she is suffering from anorexia during which he/she has developed psychotic symptoms, usually thematically associated with eating. Studies published so far, mainly case reports, point to the complex nature of the interrelationships between schizophrenia and anorexia nervosa. Further research is needed to conclusively explain the relationships between psychotic disorders and anorexia nervosa, which would allow physicians to use more effective methods of treatment in this group of patients.

  16. The Treatment of Anorexia Nervosa and Bulimia: A Multidimensional Group Approach.

    Science.gov (United States)

    Richards, P. Scott

    This paper defines the eating disorders of anorexia nervosa, bulimia, and bulimia nervosa, a bulimic subtype of anorexia nervosa. The diagnosis of these disorders is discussed and similarities and differences among the three disorders are reviewed. Etiological factors are considered and current trends in treatment of anorexia nervosa, bulimia, and…

  17. [Subjective family image in anorexia nervosa and bulimia nervosa in adolescence: a controlled study].

    Science.gov (United States)

    Karwautz, A; Haidvogl, M; Wagner, G; Nobis, G; Wöber-Bingöl, C; Friedrich, M H

    2002-11-01

    The family environments of patients with eating disorders have been studied extensively in recent decades. The "Subjective Family Image Test" is an instrument developed especially to measure differential perceptions by family members. Assessments of subjective family image in families of adolescents by means of this test have been carried out in only a few samples. We aimed first to investigate subjective perceptions by adolescents of their family relations in a larger clinical sample of female adolescents (n = 118) suffering from anorexia nervosa of either subtype or from bulimia nervosa and to compare these perceptions with those of healthy controls (n = 96). Second we investigated intra-familial differences in perception. The main findings were that bulimia nervosa patients perceived lower individual autonomy and lower emotional connectedness than all other groups, the adolescents with bulimia perceived significantly lower autonomy and emotional connectedness within the family than their fathers, and the restrictive anorexia nervosa patients perceived higher connectedness than their fathers. The relevance of these findings for understanding family dynamics are discussed.

  18. Understanding the relationships between body esteem, risk for anorexia nervosa, and domain-dependent decision-making impulsivity in a college sample.

    Science.gov (United States)

    Lilienthal, Kaitlin R; Weatherly, Jeffrey N

    2013-09-01

    Impulsivity has been suggested to interact with low body esteem to elevate risk for anorexia nervosa. Discounting tasks are unique tools for examining impulsivity. Female college students (N=139) at varying levels of body esteem and risk for anorexia nervosa responded to discounting scenarios depicting opportunities to lose/gain weight and to worsen/improve complexion. Multiple regression analyses were used to examine the relationships between impulsivity and risk for anorexia nervosa and body esteem in four disorder-relevant decision-making contexts. Results indicated that lower decision-making impulsivity predicted lower body esteem levels when the outcome of the task was framed as an opportunity to lose weight. It is suggested that greater self-control regarding weight-loss in women with low body esteem may be problematic, placing them at higher risk for eating- and weight-related problems. Results reiterate the need for continued attention to fostering healthy body esteem and weight-control patterns in women on college campuses. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Indirect evidence for decreased hypothalamic somatostatinergic tone in anorexia nervosa

    DEFF Research Database (Denmark)

    Stoving, R.K.; Andersen, M.; Flyvbjerg, A.

    2002-01-01

    in the central feeding mechanism in anorexia nervosa (AN). Peripheral administration of pyridostigmine (PD) minimizes the release of hypothalamic SRIH. DESIGN: To study the influence of hypothalamic somatostatinergic inhibition on the exaggerated somatotroph responsiveness to GHRH in patients with severe AN, two...... indirectly to greater SRIH withdrawal and greater GHRH release in anorexia nervosa. Moreover, hypothalamic SRIH activity seems to be inversely related to cortisol levels, indirectly supporting the hypothesis that SRIH and CRH neuronal activity are inversely related in anorexia nervosa. Leptin, which...... is believed to act on hypothalamic feeding mechanisms, seems to be positively related to SRIH activity. Finally, the present data demonstrate that the potentiating effect of pyridostigmine in anorexia nervosa is related to body mass index and increases upon weight gain, suggesting that the low...

  20. How to Feed a Patient with Anorexia Nervosa?

    Directory of Open Access Journals (Sweden)

    D.O. Ptushkina

    2015-11-01

    Full Text Available The article presents the problems of nutritional rehabilitation of patients with anorexia nervosa, methods for evaluation of nutritional status, eating behavior, weight restoration and weight gain rates, stages of treatment, enteral nutrition.

  1. Reduced perception of bodily signals in anorexia nervosa.

    Science.gov (United States)

    Pollatos, Olga; Kurz, Anne-Lene; Albrecht, Jessica; Schreder, Tatjana; Kleemann, Anna Maria; Schöpf, Veronika; Kopietz, Rainer; Wiesmann, Martin; Schandry, Rainer

    2008-12-01

    Interoceptive awareness is known to be impaired in eating disorders. To date, it has remained unclear whether this variable is related to the construct of interoceptive sensitivity. Interoceptive sensitivity is considered to be an essential variable in emotional processes. The objective of the study was to elucidate this potential relationship and to clarify whether general interoceptive sensitivity is reduced in anorexia nervosa. Using a heartbeat perception task, interoceptive sensitivity was assessed in 28 female patients with anorexia nervosa and 28 matched healthy controls. Questionnaires assessing interoceptive awareness (EDI) and several other variables were also administered. Patients with anorexia nervosa displayed significantly decreased interoceptive sensitivity. They also had more difficulties in interoceptive awareness. In addition to a decreased ability to recognize certain visceral sensations related to hunger, there is a generally reduced capacity to accurately perceive bodily signals in anorexia nervosa. This highlights the potential importance of interoceptive sensitivity in the pathogenesis of eating disorders.

  2. Neurobiology of hyperactivity and reward : Agreeable restlessness in Anorexia Nervosa

    NARCIS (Netherlands)

    Scheurink, Anton J. W.; Boersma, Gretha J.; Nergardh, Ricard; Sodersten, Per; Nergårdh, Ricard; Södersten, Per

    2010-01-01

    Restricted food intake is associated with increased physical activity, very likely an evolutionary advantage, initially both functional and rewarding. The hyperactivity of patients with Anorexia Nervosa, however, is a main problem for recovery. This seemingly paradoxical reward of hyperactivity in

  3. Neurobiology of anorexia and bulimia nervosa.

    Science.gov (United States)

    Kaye, Walter

    2008-04-22

    Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders of unknown etiology that most commonly begin during adolescence in women. AN and BN have unique and puzzling symptoms, such as restricted eating or binge-purge behaviors, body image distortions, denial of emaciation, and resistance to treatment. These are often chronic and relapsing disorders, and AN has the highest death rate of any psychiatric disorder. The lack of understanding of the pathogenesis of this illness has hindered the development of effective interventions, particularly for AN. Individuals with AN and BN are consistently characterized by perfectionism, obsessive-compulsiveness, and dysphoric mood. Individuals with AN tend to have high constraint, constriction of affect and emotional expressiveness, ahendonia and asceticism, whereas individuals with BN tend to be more impulsive and sensation seeking. Such symptoms often begin in childhood, before the onset of an eating disorder, and persist after recovery, suggesting they are traits that create a vulnerability for developing an ED. There is growing acknowledgement that neurobiological vulnerabilities make a substantial contribution to the pathogenesis of AN and BN. Considerable evidence suggests that altered brain serotonin (5-HT) function contributes to dysregulation of appetite, mood, and impulse control in AN and BN. Brain imaging studies, using 5-HT specific ligands, show that disturbances of 5-HT function occur when people are ill, and persist after recovery from AN and BN. It is possible that a trait-related disturbance of 5-HT neuronal modulation predates the onset of AN and contributes to premorbid symptoms of anxiety, obsessionality, and inhibition. This dysphoric temperament may involve an inherent dysregulation of emotional and reward pathways which also mediate the hedonic aspects of feeding, thus making these individuals vulnerable to disturbed appetitive behaviors. Restricting food intake may become powerfully

  4. The Anorexia Nervosa Genetics Initiative: Study description and sample characteristics of the Australian and New Zealand arm.

    Science.gov (United States)

    Kirk, Katherine M; Martin, Felicity C; Mao, Amy; Parker, Richard; Maguire, Sarah; Thornton, Laura M; Zhu, Gu; McAloney, Kerrie; Freeman, Jeremy L; Hay, Phillipa; Madden, Sloane; Morgan, Christine; Russell, Janice; Sawyer, Susan M; Hughes, Elizabeth K; Fairweather-Schmidt, A Kate; Fursland, Anthea; McCormack, Julie; Wagg, Fiona; Jordan, Jennifer; Kennedy, Martin A; Ward, Warren; Wade, Tracey D; Bulik, Cynthia M; Martin, Nicholas G

    2017-06-01

    Anorexia nervosa is a severe psychiatric disorder with high mortality rates. While its aetiology is poorly understood, there is evidence of a significant genetic component. The Anorexia Nervosa Genetics Initiative is an international collaboration which aims to understand the genetic basis of the disorder. This paper describes the recruitment and characteristics of the Australasian Anorexia Nervosa Genetics Initiative sample, the largest sample of individuals with anorexia nervosa ever assembled across Australia and New Zealand. Participants completed an online questionnaire based on the Structured Clinical Interview Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) eating disorders section. Participants who met specified case criteria for lifetime anorexia nervosa were requested to provide a DNA sample for genetic analysis. Overall, the study recruited 3414 Australians and 543 New Zealanders meeting the lifetime anorexia nervosa case criteria by using a variety of conventional and social media recruitment methods. At the time of questionnaire completion, 28% had a body mass index ⩽ 18.5 kg/m 2 . Fasting and exercise were the most commonly employed methods of weight control, and were associated with the youngest reported ages of onset. At the time of the study, 32% of participants meeting lifetime anorexia nervosa case criteria were under the care of a medical practitioner; those with current body mass index anorexia nervosa in Australia and New Zealand to date. The proportion of people with anorexia nervosa currently receiving medical care, and the most common sources of treatment accessed, indicates the importance of training for general practitioners and dietitians in treating anorexia nervosa.

  5. Could dopamine agonists aid in drug development for anorexia nervosa?

    Science.gov (United States)

    Frank, Guido K W

    2014-01-01

    Anorexia nervosa is a severe psychiatric disorder most commonly starting during the teenage-years and associated with food refusal and low body weight. Typically there is a loss of menses, intense fear of gaining weight, and an often delusional quality of altered body perception. Anorexia nervosa is also associated with a pattern of high cognitive rigidity, which may contribute to treatment resistance and relapse. The complex interplay of state and trait biological, psychological, and social factors has complicated identifying neurobiological mechanisms that contribute to the illness. The dopamine D1 and D2 neurotransmitter receptors are involved in motivational aspects of food approach, fear extinction, and cognitive flexibility. They could therefore be important targets to improve core and associated behaviors in anorexia nervosa. Treatment with dopamine antagonists has shown little benefit, and it is possible that antagonists over time increase an already hypersensitive dopamine pathway activity in anorexia nervosa. On the contrary, application of dopamine receptor agonists could reduce circuit responsiveness, facilitate fear extinction, and improve cognitive flexibility in anorexia nervosa, as they may be particularly effective during underweight and low gonadal hormone states. This article provides evidence that the dopamine receptor system could be a key factor in the pathophysiology of anorexia nervosa and dopamine agonists could be helpful in reducing core symptoms of the disorder. This review is a theoretical approach that primarily focuses on dopamine receptor function as this system has been mechanistically better described than other neurotransmitters that are altered in anorexia nervosa. However, those proposed dopamine mechanisms in anorexia nervosa also warrant further study with respect to their interaction with other neurotransmitter systems, such as serotonin pathways.

  6. Could Dopamine Agonists Aid in Drug Development for Anorexia Nervosa?

    Science.gov (United States)

    Frank, Guido K. W.

    2014-01-01

    Anorexia nervosa is a severe psychiatric disorder most commonly starting during the teenage-years and associated with food refusal and low body weight. Typically there is a loss of menses, intense fear of gaining weight, and an often delusional quality of altered body perception. Anorexia nervosa is also associated with a pattern of high cognitive rigidity, which may contribute to treatment resistance and relapse. The complex interplay of state and trait biological, psychological, and social factors has complicated identifying neurobiological mechanisms that contribute to the illness. The dopamine D1 and D2 neurotransmitter receptors are involved in motivational aspects of food approach, fear extinction, and cognitive flexibility. They could therefore be important targets to improve core and associated behaviors in anorexia nervosa. Treatment with dopamine antagonists has shown little benefit, and it is possible that antagonists over time increase an already hypersensitive dopamine pathway activity in anorexia nervosa. On the contrary, application of dopamine receptor agonists could reduce circuit responsiveness, facilitate fear extinction, and improve cognitive flexibility in anorexia nervosa, as they may be particularly effective during underweight and low gonadal hormone states. This article provides evidence that the dopamine receptor system could be a key factor in the pathophysiology of anorexia nervosa and dopamine agonists could be helpful in reducing core symptoms of the disorder. This review is a theoretical approach that primarily focuses on dopamine receptor function as this system has been mechanistically better described than other neurotransmitters that are altered in anorexia nervosa. However, those proposed dopamine mechanisms in anorexia nervosa also warrant further study with respect to their interaction with other neurotransmitter systems, such as serotonin pathways. PMID:25988121

  7. Could Dopamine Agonists Aid in Drug Development for Anorexia Nervosa?

    Directory of Open Access Journals (Sweden)

    Guido eFrank

    2014-11-01

    Full Text Available Anorexia nervosa is a severe psychiatric disorder most commonly starting during the teenage years and associated with food refusal and low body weight. Typically there is a loss of menses, intense fear of gaining weight and an often delusional quality of altered body perception. Anorexia nervosa is also associated with a pattern of high cognitive rigidity, which may contribute to treatment resistance and relapse. The complex interplay of state and trait biological, psychological and social factors has complicated identifying neurobiological mechanisms that contribute to the illness. The dopamine D1 and D2 neurotransmitter receptors are involved in motivational aspects of food approach, fear extinction and cognitive flexibility. They could therefore be important targets to improve core and associated behaviors in anorexia nervosa. Treatment with dopamine antagonists has shown little benefit, and it is possible that antagonists over time increase an already hypersensitive dopamine pathway activity in anorexia nervosa. On the contrary, application of dopamine receptor agonists could reduce circuit responsiveness, facilitate fear extinction and improve cognitive flexibility in anorexia nervosa, as they may be particularly effective during underweight and low gonadal hormone states. This article provides evidence that the dopamine receptor system could be a key factor in the pathophysiology of anorexia nervosa and dopamine agonists could be helpful in reducing core symptoms of the disorder. This review is a theoretical approach that primarily focuses on dopamine receptor function as this system has been mechanistically better described than other neurotransmitters that are altered in anorexia nervosa. However, those proposed dopamine mechanisms in anorexia nervosa also warrant further study with respect to their interaction with other neurotransmitter systems, such as serotonin pathways.

  8. [Anesthesia in patients with anorexia nervosa and bulimia nervosa].

    Science.gov (United States)

    Zenker, J; Hagenah, U; Rossaint, R

    2010-03-01

    Eating disorders are typical diseases of adolescence and early adulthood. About 1-3% of female juveniles suffer from anorexia nervosa (AN) or bulimia nervosa (BN). Today AN is still the psychiatric disease with the highest mortality rate. The peri-operative mortality rate of patients suffering from AN is in the range up to 15%. The beginning of AN is a lingering process and the majority of patients show increasingly restrictive eating habits ending in cachexia. Patients are obsessed by the predominant idea of being obese in spite of having a significant underweight. Patients suffering from bulimia break the strict regimen by eating enormous amounts of high calorie food. Such eating attacks are followed by weight reducing measures, mostly vomiting. Most of the physical changes caused by AN are due to starvation and loss of weight. The most significant medical complications are alterations of the cardiovascular system accompanied by decreasing contractility of the heart, bradycardia, electrocardiographic changes as well as disequilibrium of electrolytic and water balance. Most of these symptoms can be reversed by putting on weight.

  9. Emotional eating in anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Ricca, Valdo; Castellini, Giovanni; Fioravanti, Giulia; Lo Sauro, Carolina; Rotella, Francesco; Ravaldi, Claudia; Lazzeretti, Lisa; Faravelli, Carlo

    2012-04-01

    The relationship between emotional states and eating behaviors is complex, and emotional eating has been identified as a possible factor triggering binge eating in bulimia nervosa (BN) and binge eating disorder. Few studies considered emotional eating in patients with anorexia nervosa. The present study evaluated the clinical correlates of emotional eating in 251 eating-disordered (EDs) subjects (70 AN restricting type, 71 AN binge eating/purging type, 110 BN purging type) and in a group of 89 healthy control subjects. Subjects were assessed by means of a clinical interview (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and several self-reported questionnaires, including the Emotional Eating Scale (EES). No significant differences were found between the 3 EDs groups in terms of EES total score, and all patients with ED showed higher EES scores compared with control subjects. Emotional eating was associated with subjective binge eating in AN binge eating/purging type and with objective binge eating in patients with BN. Among patients with AN restricting type, emotional eating was associated with restraint, but this association was lost when controlling for fear of loss of control over eating, which was the principal determinant of restraint. Emotional eating and fear of loss of control over eating are significantly associated with specific eating attitudes and behaviors, according to the different diagnoses. Emotional eating is a relevant psychopathologic dimension that deserves a careful investigation in both anorectic and bulimic patients. Copyright © 2012 Elsevier Inc. All rights reserved.

  10. Oral mucosal lesions in Anorexia Nervosa, Bulimia Nervosa and EDNOS.

    Science.gov (United States)

    Panico, Rene; Piemonte, Eduardo; Lazos, Jerónimo; Gilligan, Gerardo; Zampini, Anibal; Lanfranchi, Héctor

    2018-01-01

    The aim of this study is to describe oral lesions in patients with eating disorders (ED), including Anorexia Nervosa (AN), Bulimia Nervosa (BN) and eating disorders not otherwise specified (EDNOS). A prospective case-control study was carried out from April 2003 to May 2004. Inclusion criteria for the study group were individuals with a diagnosis of ED; age and sex-matched individuals without ED were included as controls. Clinical data regarding ED, medical complications and oral examination were performed by previously calibrated professionals. Study group (n = 65) presented 46 cases of BN (71%), 13 of EDNOS (20%) and 6 of AN (9%); also, 94% (n = 61) showed oral lesions. The most common were: labial erythema, exfoliative cheilitis, orange-yellow palate, hemorrhagic lesions, lip-cheek biting and non-specific oral atrophies. Only two patients of the study group had dental erosions, and no case of major salivary gland swelling was found. ED display a wide array of oral mucosal lesions that can be regarded as their early manifestations. The dentist could be the first professional to detect symptoms of eating disorders, potentially improving early detection and treatment of ED. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Neuropsychological function in patients with anorexia nervosa or bulimia nervosa.

    Science.gov (United States)

    Weider, Siri; Indredavik, Marit Saebø; Lydersen, Stian; Hestad, Knut

    2015-05-01

    This study explored the neuropsychological performance of patients diagnosed with anorexia nervosa (AN) or bulimia nervosa (BN) compared with healthy controls (HCs). An additional aim was to investigate the effect of several possible mediators on the association between eating disorders (EDs) and cognitive function. Forty patients with AN, 39 patients with BN, and 40 HCs who were comparable in age and education were consecutively recruited to complete a standardized neuropsychological test battery covering the following cognitive domains: verbal learning and memory, visual learning and memory, speed of information processing, visuospatial ability, working memory, executive function, verbal fluency, attention/vigilance, and motor function. The AN group scored significantly below the HCs on eight of the nine measured cognitive domains. The BN group also showed inferior performance on six cognitive domains. After adjusting for possible mediators, the nadir body mass index (lowest lifetime BMI) and depressive symptoms explained all findings in the BN group. Although this adjustment reduced the difference between the AN and HC groups, the AN group still performed worse than the HCs regarding verbal learning and memory, visual learning and memory, visuospatial ability, working memory, and executive functioning. Patients with EDs scored below the HCs on several cognitive function measures, this difference being most pronounced for the AN group. The nadir BMI and depressive symptoms had strong mediating effects. Longitudinal studies are needed to identify the importance of weight restoration and treatment of depressive symptoms in the prevention of a possible cognitive decline. © 2014 Wiley Periodicals, Inc.

  12. Cognitive processing of emotions in anorexia nervosa.

    Science.gov (United States)

    Torres, Sandra; Guerra, Marina Prista; Lencastre, Leonor; Roma-Torres, António; Brandão, Isabel; Queirós, Cristina; Vieira, Filipa

    2011-01-01

    This study attempts to explore the cognitive processing of emotions in anorexia nervosa (AN), based on the study of emotions felt and the assessment of meta-emotional abilities. Eighty patients with AN and a control group of 80 healthy female participants were screened for anxiety, depression and alexithymia and completed an experimental task designed to analyse the emotional experience and meta-emotional abilities. Despite presenting higher levels of alexithymia, participants with AN demonstrated they were able to imagine emotions in hypothetical situations and to identify and label them. The group of patients with AN revealed feeling more intense and internally based negative emotions in comparison with the control group, but this emotional pattern tends to occur in situations associated with food and weight. Findings on meta-emotional abilities suggested no global deficit in emotional processing, but rather, specific sensitivities pertaining to situations relevant to AN. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

  13. Worse survival after breast cancer in women with anorexia nervosa.

    Science.gov (United States)

    Bens, Annet; Papadopoulos, Fotios C; Pukkala, Eero; Ekbom, Anders; Gissler, Mika; Mellemkjær, Lene

    2018-04-01

    A history of anorexia nervosa has been associated with a reduced risk of developing breast cancer. We investigated survival after breast cancer among women with a prior anorexia nervosa diagnosis compared with women in a population comparison group. This register-based study included combined data from Sweden, Denmark and Finland. A total of 76 and 1462 breast cancer cases identified among 22,654 women with anorexia nervosa and 224,619 women in a population comparison group, respectively, were included in the study. Hazard ratios (HR) for overall and breast cancer-specific mortality after breast cancer diagnosis were estimated using Cox regression. Cause of death was available only for Swedish and Danish women; therefore, the analysis on breast cancer-specific mortality was restricted to these women. We observed 23 deaths after breast cancer among anorexia nervosa patients and 247 among population comparisons. The overall mortality after the breast cancer diagnosis was increased in women with a history of anorexia nervosa compared with population comparisons (HR 2.5, 95% CI 1.6-3.9) after adjustment for age, period and extent of disease. Results were similar for overall (HR 2.3, 95% CI 1.4-3.6) and breast cancer-specific mortality (HR 2.1, 95% CI 1.3-3.6) among Swedish and Danish women. We found that female breast cancer patients with a prior diagnosis of anorexia nervosa have a worse survival compared with other breast cancer patients.

  14. Social Cognition in Child and Adolescents with Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    ipek Percinel

    2015-06-01

    Full Text Available Social cognition represents the mental processes of social interaction between oneself and others. In recent years, the interest in social cognition skills has increased in cases with eating disorders. Anorexia nervosa is an eating disorder that is associated with the multiple factors in etiology. Treatment of anorexia nervosa is still controversial. The youths diagnosed with anorexia nervosa are known to be as the most difficult group in eating disorders for building therapeutic relations. Studies, mostly suggests that there are difficulties in social cognitive functions in patients with anorexia nervosa. However, there are studies that reported different results. It seems that, the majority of studies which evaluate the social cognitive functions in patients with anorexia nervosa, are carried out with the adult age group. There are limited number of studies in child and adolescent age group. The purpose of this paper was to examinate the studies of social cognitive skills in children and adolescents diagnosed with anorexia nervosa and present the general characteristics. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2015; 7(2: 178-189

  15. The Egosyntonic Nature of Anorexia: An Impediment to Recovery in Anorexia Nervosa Treatment

    Directory of Open Access Journals (Sweden)

    Eva C. Gregertsen

    2017-12-01

    Full Text Available A serious problem faced by clinicians treating anorexia nervosa is the egosyntonic nature of the illness, wherein individuals with anorexia nervosa value their disorder, thereby hindering motivation for recovery and engagement with treatment. The objective of this review article is to elucidate the nature of egosyntonicity in anorexia nervosa, reviewing both qualitative and quantitative research pertaining to this topic, and, importantly, to present methods to overcome this impediment to recovery in anorexia nervosa treatment. The authors elucidate functions of anorexia nervosa for patients, both within psychological and social spheres, as well as highlight the detrimental effect of egosyntonicity in terms of illness severity and motivation for recovery. The final part of the paper contains suggestions as to methods of bypassing pitfalls linked with the influence of the egosyntonic nature of anorexia nervosa within a treatment setting, as well as an examination of three current treatments (enhanced cognitive-behavioral therapy for eating disorders, Maudsley Model of Anorexia Nervosa Treatment for Adults, and Specialist Supportive Clinical Management in terms of the degree to which they target egosyntonicity.

  16. Recovery From Anorexia Nervosa and Bulimia Nervosa at 22-Year Follow-Up.

    Science.gov (United States)

    Eddy, Kamryn T; Tabri, Nassim; Thomas, Jennifer J; Murray, Helen B; Keshaviah, Aparna; Hastings, Elizabeth; Edkins, Katherine; Krishna, Meera; Herzog, David B; Keel, Pamela K; Franko, Debra L

    2017-02-01

    The course of eating disorders is often protracted, with fewer than half of adults achieving recovery from anorexia nervosa or bulimia nervosa. Some argue for palliative management when duration exceeds a decade, yet outcomes beyond 20 years are rarely described. This study investigates early and long-term recovery in the Massachusetts General Hospital Longitudinal Study of Anorexia and Bulimia Nervosa. Females with DSM-III-R/DSM-IV anorexia nervosa or bulimia nervosa were assessed at 9 and at 20 to 25 years of follow-up (mean [SD] = 22.10 [1.10] years; study initiated in 1987, last follow-up conducted in 2013) via structured clinical interview (Longitudinal Interval Follow-Up Evaluation of Eating Disorders [LIFE-EAT-II]). Seventy-seven percent of the original cohort was re-interviewed, and multiple imputation was used to include all surviving participants from the original cohort (N = 228). Kaplan-Meier curves estimated recovery by 9-year follow-up, and McNemar test examined concordance between recovery at 9-year and 22-year follow-up. At 22-year follow-up, 62.8% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa recovered, compared to 31.4% of participants with anorexia nervosa and 68.2% of participants with bulimia nervosa by 9-year follow-up. Approximately half of those with anorexia nervosa who had not recovered by 9 years progressed to recovery at 22 years. Early recovery was associated with increased likelihood of long-term recovery in anorexia nervosa (odds ratio [OR] = 10.5; 95% CI, 3.77-29.28; McNemar χ²₁ = 31.39; P bulimia nervosa (OR = 1.0; 95% CI, 0.49-2.05; McNemar χ²₁ = 0; P = 1.0). At 22 years, approximately two-thirds of females with anorexia nervosa and bulimia nervosa were recovered. Recovery from bulimia nervosa happened earlier, but recovery from anorexia nervosa continued over the long term, arguing against the implementation of palliative care for most individuals with eating disorders. © Copyright

  17. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Harrington, Brian C; Jimerson, Michelle; Haxton, Christina; Jimerson, David C

    2015-01-01

    Eating disorders are life-threatening conditions that are challenging to address; however, the primary care setting provides an important opportunity for critical medical and psychosocial intervention. The recently published Diagnostic and Statistical Manual of Mental Disorders, 5th ed., includes updated diagnostic criteria for anorexia nervosa (e.g., elimination of amenorrhea as a diagnostic criterion) and for bulimia nervosa (e.g., criterion for frequency of binge episodes decreased to an average of once per week). In addition to the role of environmental triggers and societal expectations of body size and shape, research has suggested that genes and discrete biochemical signals contribute to the development of eating disorders. Anorexia nervosa and bulimia nervosa occur most often in adolescent females and are often accompanied by depression and other comorbid psychiatric disorders. For low-weight patients with anorexia nervosa, virtually all physiologic systems are affected, ranging from hypotension and osteopenia to life-threatening arrhythmias, often requiring emergent assessment and hospitalization for metabolic stabilization. In patients with frequent purging or laxative abuse, the presence of electrolyte abnormalities requires prompt intervention. Family-based treatment is helpful for adolescents with anorexia nervosa, whereas short-term psychotherapy, such as cognitive behavior therapy, is effective for most patients with bulimia nervosa. The use of psychotropic medications is limited for anorexia nervosa, whereas treatment studies have shown a benefit of antidepressant medications for patients with bulimia nervosa. Treatment is most effective when it includes a multidisciplinary, teambased approach.

  18. Epidemiology of anorexia nervosa and bulimia nervosa in Bornholm County, Denmark, 1970-1989

    DEFF Research Database (Denmark)

    Pagsberg, A K; Wang, A R

    1994-01-01

    In a retrospective study of anorexia nervosa and bulimia nervosa, potential cases were traced, studied, and diagnosed according to ICD-10. Forty-two cases were found in Bornholm County, comprising the island of Bornholm in Denmark, in a population of 47,000 from 1970 to 1989. Less than half...... the number of cases in the population year by year, also increased during the late part of the study period. In 1989 the incidence rate of the high-risk group of females 10 to 24 years of age was 136 per 100,000 for anorexia nervosa and 45 per 100,000 for bulimia nervosa, and the prevalence rate was 222 per...... 100,000 for anorexia nervosa and 89 per 100,000 for bulimia nervosa....

  19. Pubertal process and green-sickness in Renaissance drama: a form fruste of anorexia nervosa?

    Science.gov (United States)

    Potter, Ursula; Bartrop, Roger; Touyz, Stephen

    2009-01-01

    The aim of this paper is to investigate the relationship between puberty and the onset of green-sickness in early modern popular culture with findings on puberty and the onset of anorexia nervosa. Four plays from the late 16th and early 17th centuries dealing with 14-15-year-old girls were analysed for information on puberty and for precipitating factors for the onset of green-sickness. These were then contrasted with the literature on anorexia nervosa where puberty has been proposed as a potential risk factor for the development of the disorder. These four plays endorse a common understanding in early modern popular culture that puberty presents a major developmental challenge for young women. Four common precipitating factors for the development of green-sickness were identified: socio-economic status; age at onset; nutrition and sexual development. These have a striking resemblance to our current understanding of the development of anorexia nervosa in adolescence. Green-sickness shares certain similarities with anorexia nervosa. It is a post menarcheal condition arising out of the body's ripeness for reproduction at around the age of 14. Affluence and improved nutrition were recognized as contributory factors. The development of both green-sickness and anorexia nervosa appear to share a common theme in the context of puberty.

  20. "Holy anorexia"-relevant or relic? Religiosity and anorexia nervosa among Finnish women.

    Science.gov (United States)

    Sipilä, Pyry; Harrasova, Gulnara; Mustelin, Linda; Rose, Richard J; Kaprio, Jaakko; Keski-Rahkonen, Anna

    2017-04-01

    Since medieval times, an association between religiosity and anorexia nervosa has been suggested, but few systematic studies exist. This study examines in a nationwide setting whether personal or family religiosity is associated with lifetime anorexia nervosa among women in adolescence and early adulthood. Women (N = 2,825) from the 1975 to 1979 birth cohorts of Finnish twins were screened for lifetime DSM-5 anorexia nervosa (N = 92). Parental religiosity was assessed by self-report when the women were aged 16 years. The women self-reported their religiosity at ages 16 and 22 to 27 years. Parental religiosity did not increase the risk of lifetime anorexia nervosa, and neither did religiosity of the women themselves in adolescence. In early adulthood, a J-shaped curve was compatible with the data, indicating increased risk both at low and high levels of religiosity, but this result was statistically non-significant. Religiosity was weakly negatively correlated with body dissatisfaction. There was some suggestive evidence for socioregional variation in the association of religiosity with lifetime anorexia nervosa. In this first population study to directly address religiosity and anorexia nervosa, no evidence was found for a significant association of religiosity with anorexia nervosa either at the personal or family level. Some regional differences are possible. A modest protective association of religiosity with body dissatisfaction is also possible. Despite compelling case descriptions of "holy anorexia," religiosity does not appear to be a central factor in the development of anorexia nervosa in Finland, a highly secularized Christian country. © 2017 Wiley Periodicals, Inc.

  1. Cardiovascular complications of anorexia nervosa: A systematic review.

    Science.gov (United States)

    Sachs, Katherine V; Harnke, Ben; Mehler, Philip S; Krantz, Mori J

    2016-03-01

    Anorexia nervosa portends the highest mortality among psychiatric diseases, despite primarily being a disease of adolescents and younger adults. Although some of this mortality risk is attributable to suicide, many deaths are likely cardiovascular in etiology. Recent studies suggest that adverse myocardial structural changes occur in this condition, which could underlie the increased mortality. Given limited prevalence of severe anorexia there is a paucity of clinical and autopsy data to discern an exact cause of death. Given this background we conducted a systematic review of the medical literature to provide a contemporary summary of the pathobiologic sequelae of severe anorexia nervosa on the cardiovascular system. We sought to elucidate the impact of anorexia nervosa in four cardiovascular domains: structural, repolarization/conduction, hemodynamic, and peripheral vascular. A number of cardiac abnormalities associated with anorexia nervosa have been described in the literature, including pericardial and valvular pathology, changes in left ventricular mass and function, conduction abnormalities, bradycardia, hypotension, and dysregulation in peripheral vascular contractility. Despite the prevalent theory that malignant arrhythmias are implicated as a cause of sudden death in this disorder, data to support this causal relationship are lacking. It is reasonable to obtain routine electrocardiography and measurements of orthostatic vital signs in patients presenting with anorexia nervosa. Echocardiography is generally not indicated unless prompted by clinical signs of disease. Admission to an inpatient unit with telemetry monitoring is recommended for patients with severe sinus bradycardia or junction rhythm, marked prolongation of the corrected QT interval, or syncope. © 2015 Wiley Periodicals, Inc.

  2. Anorexia nervosa and bulimia nervosa: A meta-analysis of executive functioning.

    Science.gov (United States)

    Hirst, Rayna B; Beard, Charlotte L; Colby, Katrina A; Quittner, Zoe; Mills, Brent M; Lavender, Jason M

    2017-12-01

    Research investigating the link between eating disorder (ED) diagnosis and executive dysfunction has had conflicting results, yet no meta-analyses have examined the overall association of ED pathology with executive functioning (EF). Effect sizes were extracted from 32 studies comparing ED groups (27 of anorexia nervosa, 9 of bulimia nervosa) with controls to determine the grand mean effect on EF. Analyses included effects for individual EF measures, as well as an age-based subgroup analysis. There was a medium effect of ED diagnosis on executive functioning, with bulimia nervosa demonstrating a larger effect (Hedges's g=-0.70) than anorexia nervosa (g=-0.41). Within anorexia nervosa studies, subgroup analyses were conducted for age and diagnostic subtype. The effect of anorexia nervosa on EF was largest in adults; however, subgroup differences for age were not significant. Anorexia and bulimia nervosa are associated with EF deficits, which are particularly notable for individuals with bulimia nervosa. The present analysis includes recommendations for future studies regarding study design and EF measurement. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Anorexia Nervosa and Bulima Nervosa Critical Analysis of It's Treatment: Implications and Interventions

    Directory of Open Access Journals (Sweden)

    Flourish Itulua-Abumere

    2013-06-01

    Full Text Available The diagnostic consideration of the eating disorders anorexia nervosa and bulimia nervosa has been given much focus over the last two decades than previously, as clinicians have become more aware of the frequency of these disorders and the difficulties associated with their treatment. Anorexia nervosa and bulimia nervosa as known in the DSM-IV as eating disorders are characterized by physically and/or psychologically harmful eating patterns. Although the psychological explanation of what we now call anorexia nervosa have been known about for centuries, it has only recently attracted much interest, due to greater public knowledge and increased incidence (according to Gross and MclLveen 2006, the latter claim has been disputed. Most people suffering from anorexia nervosa and bulimia nervosa start by fasting. Anorexia nervosa is a deliberate self-starvation. A person whose body weight is less than expected for his or her body height and weight is considered to be anorexic. In contract, bulimia involves binge eating a large quantity of food followed by purging by self-induced vomiting, enemas, laxatives, or diuretics.

  4. A review of endocrine changes in anorexia nervosa

    DEFF Research Database (Denmark)

    Støving, R K; Hangaard, J; Hansen-Nord, M

    1999-01-01

    Anorexia nervosa is a syndrome of unknown etiology. It is associated with multiple endocrine abnormalities. Hypothalamic monoamines (especially serotonin), neuropeptides (especially neuropeptide Y and cholecystokinin) and leptin are involved in the regulation of human appetite, and in several ways...... they are changed in anorexia nervosa. However, it remains to be clarified whether the altered appetite regulation is secondary or etiologic. Increased secretion of corticotropin-releasing hormone and proopiomelanocortin seems to be secondary to starvation, however, there is evidence that it may maintain...... and intensify anorexia, excessive physical activity and amenorrhea. Hypothalamic amenorrhea, which is a diagnostic criterion in anorexia nervosa, is not solely related to the low body weight and exercise. Growth hormone resistance with low production of insulin-like growth factor I and high growth hormone...

  5. A review of endocrine changes in anorexia nervosa

    DEFF Research Database (Denmark)

    Støving, R K; Hangaard, J; Hansen-Nord, M

    1999-01-01

    and intensify anorexia, excessive physical activity and amenorrhea. Hypothalamic amenorrhea, which is a diagnostic criterion in anorexia nervosa, is not solely related to the low body weight and exercise. Growth hormone resistance with low production of insulin-like growth factor I and high growth hormone......Anorexia nervosa is a syndrome of unknown etiology. It is associated with multiple endocrine abnormalities. Hypothalamic monoamines (especially serotonin), neuropeptides (especially neuropeptide Y and cholecystokinin) and leptin are involved in the regulation of human appetite, and in several ways...... they are changed in anorexia nervosa. However, it remains to be clarified whether the altered appetite regulation is secondary or etiologic. Increased secretion of corticotropin-releasing hormone and proopiomelanocortin seems to be secondary to starvation, however, there is evidence that it may maintain...

  6. Anorexia Nervosa: Analysis of Trabecular Texture with CT.

    Science.gov (United States)

    Tabari, Azadeh; Torriani, Martin; Miller, Karen K; Klibanski, Anne; Kalra, Mannudeep K; Bredella, Miriam A

    2017-04-01

    Purpose To determine indexes of skeletal integrity by using computed tomographic (CT) trabecular texture analysis of the lumbar spine in patients with anorexia nervosa and normal-weight control subjects and to determine body composition predictors of trabecular texture. Materials and Methods This cross-sectional study was approved by the institutional review board and compliant with HIPAA. Written informed consent was obtained. The study included 30 women with anorexia nervosa (mean age ± standard deviation, 26 years ± 6) and 30 normal-weight age-matched women (control group). All participants underwent low-dose single-section quantitative CT of the L4 vertebral body with use of a calibration phantom. Trabecular texture analysis was performed by using software. Skewness (asymmetry of gray-level pixel distribution), kurtosis (pointiness of pixel distribution), entropy (inhomogeneity of pixel distribution), and mean value of positive pixels (MPP) were assessed. Bone mineral density and abdominal fat and paraspinal muscle areas were quantified with quantitative CT. Women with anorexia nervosa and normal-weight control subjects were compared by using the Student t test. Linear regression analyses were performed to determine associations between trabecular texture and body composition. Results Women with anorexia nervosa had higher skewness and kurtosis, lower MPP (P anorexia nervosa. Conclusion Patients with anorexia nervosa had increased skewness and kurtosis and decreased entropy and MPP compared with normal-weight control subjects. These parameters were associated with lowest lifetime weight and duration of amenorrhea, but there were no such associations with bone mineral density. These findings suggest that trabecular texture analysis might contribute information about bone health in anorexia nervosa that is independent of that provided with bone mineral density. © RSNA, 2016.

  7. [Study of parental bonding in childhood in children and adolescents with anorexia nervosa].

    Science.gov (United States)

    Albinhac, A M H; Jean, F A M; Bouvard, M P

    2018-04-16

    index. Our study shows a rating by the parents of warm and understanding parents, an over-protective mother and a father encouraging autonomy. There is maternal and paternal overprotection in pubertal anorexia nervosa compared with peripubertals. Our results suggest the importance of analyzing parenting style in addition to Parental Bonding Instruments results and of supporting the importance of the development of family therapy in the anorexia nervosa. Copyright © 2018 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

  8. Psychopharmacotherapy of anorexia nervosa, bulimia nervosa and binge-eating disorder

    OpenAIRE

    Kruger, S; Kennedy, SH

    2000-01-01

    Pharmacotherapy for anorexia nervosa is considered to be of limited efficacy. However, many studies suffer methodological limitations, and the utility of newer drugs in the treatment of anorexia has not been examined yet. Although there have been more fruitful investigations on the efficacy of medication in the management of bulimia nervosa, there are still many unresolved issues regarding the optimal management of partial remission during the acute treatment phase and the intensity and durat...

  9. Body composition in men with anorexia nervosa: Longitudinal study.

    Science.gov (United States)

    El Ghoch, Marwan; Calugi, Simona; Milanese, Chiara; Bazzani, Paola Vittoria; Dalle Grave, Riccardo

    2017-07-01

    To compare body composition patterns before and after complete weight restoration in men with anorexia nervosa. Dual-energy X-ray absorptiometry (DXA) was used to measure body composition patterns in 10 men with anorexia nervosa before and after complete weight restoration, and in 10 healthy men matched to age and patients' post-treatment body mass index (BMI). Before weight restoration, men with anorexia nervosa displayed lower total body fat mass (FM) and lean mass (LBM) than those in the healthy comparison group, with a greater FM loss from the extremity than the trunk region. After short-term weight restoration, patients displayed complete normalization in total LBM and FM, but greater deposition of FM in the trunk region. Short-term weight restoration can normalize body composition patterns in men with anorexia nervosa, but results in a central adiposity phenotype. The clinical implication of this finding is unknown, but should be explored given the high levels of concern about central adiposity in anorexia nervosa. © 2017 Wiley Periodicals, Inc.

  10. Total body water and total body potassium in anorexia nervosa

    Energy Technology Data Exchange (ETDEWEB)

    Dempsey, D.T.; Crosby, L.O.; Lusk, E.; Oberlander, J.L.; Pertschuk, M.J.; Mullen, J.L.

    1984-08-01

    In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation.

  11. Neurofunctional areas related to food appetency in anorexia nervosa

    Directory of Open Access Journals (Sweden)

    Juán José Cervantes-Navarrete

    2012-07-01

    Full Text Available In Anorexia Nervosa the observable phenomenon is the suppression of appetite. Little is known about the biological and psychological (top-down bases that maintain this pathological state. However, Anorexia Nervosa is a biological, psychological and social model where the main behavioral characteristic is the inhibition of eating behavior; not by bottom-up but top-down regulation. Objective: To explore the areas of the brain associated with food appetency through functional magnetic resonance in women with anorexia nervosa. Methods: The subjects include 5 female with Restrictive type of Anorexia Nervosa and five controls female with similar in age and low weigh. The subjects were within the MRI scanner and while took fMRI they saw food images that would generate appetite. The subjects were in fasting state and mentally prepare by instruction “imagine you are eating the food presented in the following images”. Results: Compared differences in the activation between subjects four regions were found significant: the anterior cingulate, left front medial region and the left and right midbrain. Conclusions: The patients with Anorexia Nervosa present different activated cerebral areas to those of the controls during the visual exposition to food in hungry state and with evoke cognitions associated with eat food; those regions may be implicated in reward and self-control.

  12. Total body water and total body potassium in anorexia nervosa

    International Nuclear Information System (INIS)

    Dempsey, D.T.; Crosby, L.O.; Lusk, E.; Oberlander, J.L.; Pertschuk, M.J.; Mullen, J.L.

    1984-01-01

    In the ill hospitalized patient with clinically relevant malnutrition, there is a measurable decrease in the ratio of the total body potassium to total body water (TBK/TBW) and a detectable increase in the ratio of total exchangeable sodium to total exchangeable potassium (Nae/Ke). To evaluate body composition analyses in anorexia nervosa patients with chronic uncomplicated semistarvation, TBK and TBW were measured by whole body K40 counting and deuterium oxide dilution in 10 females with stable anorexia nervosa and 10 age-matched female controls. The ratio of TBK/TBW was significantly (p less than 0.05) higher in anorexia nervosa patients than controls. The close inverse correlation found in published studies between TBK/TBW and Nae/Ke together with our results suggest that in anorexia nervosa, Nae/Ke may be low or normal. A decreased TBK/TBW is not a good indicator of malnutrition in the anorexia nervosa patient. The use of a decreased TBK/TBW ratio or an elevated Nae/Ke ratio as a definition of malnutrition may result in inappropriate nutritional management in the patient with severe nonstressed chronic semistarvation

  13. Wait Not, Want Not: Factors Contributing to the Development of Anorexia Nervosa and Bulimia Nervosa.

    Science.gov (United States)

    Murray, Trish

    2003-01-01

    The purpose of this literature review is to examine prevalence and incident rates of both anorexia nervosa and bulimia nervosa. In addition, this article will review the psychological and sociological factors that contribute to the development and maintenance of an eating disorder. Finally, different treatment approaches will be discussed in…

  14. Anorexia nervosa versus bulimia nervosa : differences based on retrospective correlates in a case-control study

    NARCIS (Netherlands)

    Machado, Barbara C.; Goncalves, Sonia F.; Martins, Carla; Brandao, Isabel; Roma-Torres, Antonio; Hoek, Hans W.; Machado, Paulo P.

    This study is the result of two Portuguese case-control studies that examined the replication of retrospective correlates and preceding life events in anorexia nervosa (AN) and bulimia nervosa (BN) development. This study aims to identify retrospective correlates that distinguish AN and BN A

  15. Epidemiology of anorexia nervosa and bulimia nervosa in Bornholm County, Denmark, 1970-1989

    DEFF Research Database (Denmark)

    Pagsberg, A K; Wang, A R

    1994-01-01

    In a retrospective study of anorexia nervosa and bulimia nervosa, potential cases were traced, studied, and diagnosed according to ICD-10. Forty-two cases were found in Bornholm County, comprising the island of Bornholm in Denmark, in a population of 47,000 from 1970 to 1989. Less than half...

  16. Motivation to change, coping, and self-esteem in adolescent anorexia nervosa: a validation study of the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ).

    Science.gov (United States)

    Pauli, Dagmar; Aebi, Marcel; Winkler Metzke, Christa; Steinhausen, Hans-Christoph

    2017-01-01

    Understanding motivation to change is a key issue in both the assessment and the treatment of eating disorders. Therefore, sound instruments assessing this construct are of great help to clinicians. Accordingly, the present study analysed the psychometric properties of the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), including its relation to coping style and self-esteem. N  = 92 adolescents referred to an eating disorders outpatient clinic meeting criteria for anorexia nervosa gave written informed consent to participate in this study and completed the ANSOCQ, the Eating Disorder Inventory, the Eating Attitudes Test, the Body Image Questionnaire, two questionnaires measuring Self-Related Cognitions and the Coping Across Situations Questionnaire. After a treatment period of nine months, clinical anorexia nervosa diagnosis and the body mass index were re-assessed. In addition to exploratory factor analysis, correlational analysis was used to test for the convergent validity of the ANSOCQ and logistic regression analysis was used to test its predictive validity. The ANSOCQ had good psychometric properties. Factor analysis yielded two meaningful factors labelled as 'weight gain and control' and 'attitudes and feelings'. Internal consistencies of the two factors amounted to Cronbach's alpha = .87 and .76, respectively. Significant correlations with other scales measuring eating disorder psychopathology were indicative of meaningful construct validity. Higher motivation to change was related to higher self-esteem and a more active coping style. Higher (positive) ANSOCQ total scores predicted remission of anorexia nervosa after nine months of treatment. A higher score on 'attitudes and feelings' was a protective factor against drop-out from intervention. The ANSOCQ is a clinically useful instrument for measuring motivation to change in adolescents with AN. Two factorial dimensions explain most of the variation. Self-esteem and coping style are

  17. Improving therapeutics in anorexia nervosa with tryptophan.

    Science.gov (United States)

    Haleem, Darakhshan Jabeen

    2017-06-01

    A growing body of evidence suggests that our diet is an important contributing factor in the development, management and prevention of a number of psychiatric illnesses. Tryptophan, an essential amino acid, is the sole precursor of neurotransmitter 5-hydroxytryptamine (5-HT; serotonin). Administration of tryptophan can boost serotonin neurotransmission to produce therapeutically important effects in serotonin deficiency disorders. Anorexia nervosa (AN) an eating disorder associated with high levels of psychiatric comorbidity including psychosis, hyperactivity, depression and anxiety has highest lethality of all psychiatric illnesses. Evidence suggests that excessive dieting and food restriction can decrease brain tryptophan and serotonin in AN patients to precipitate depression, psychosis and hyperactivity. There are currently no FDA approved pharmacological treatments available for AN patients; antidepressants and antipsychotics, largely used to treat associated psychiatric comorbidities are also not very effective. The aim of this non-systematic review article is to evaluate and document a potential importance of tryptophan supplementation in improving therapeutics in AN patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Altered Implicit Category Learning in Anorexia Nervosa

    Science.gov (United States)

    Shott, Megan E.; Filoteo, J. Vincent; Jappe, Leah M.; Pryor, Tamara; Maddox, W. Todd; Rollin, Michael D.H.; Hagman, Jennifer O.; Frank, Guido K.W.

    2012-01-01

    Objective Recent research has identified specific cognitive deficits in patients with anorexia nervosa (AN), including impairment in executive functioning and attention. Another such cognitive process, implicit category learning has been less studied in AN. This study examined whether implicit category learning is impaired in AN. Method Twenty-one women diagnosed with AN and 19 control women (CW) were administered an implicit category learning task in which they were asked to categorize simple perceptual stimuli (Gabor patches) into one of two categories. Category membership was based on a linear integration (i.e., an implicit task) of two stimulus dimensions (orientation and spatial frequency of the stimulus). Results AN individuals were less accurate on implicit category learning relative to age-matched CW. Model-based analyses indicated that, even when AN individuals used the appropriate (i.e., implicit) strategy they were still impaired relative to CW who also used the same strategy. In addition, task performance in AN patients was worse the higher they were in self-reported novelty seeking and the lower they were in sensitivity to punishment. Conclusions These results indicate that AN patients have implicit category learning deficits, and given this type of learning is thought to be mediated by striatal dopamine pathways, AN patients may have deficits in these neural systems. The finding of significant correlations with novelty seeking and sensitivity to punishment suggests that feedback sensitivity is related to implicit learning in AN. PMID:22201300

  19. Emotion coupling and regulation in anorexia nervosa.

    Science.gov (United States)

    Fox, John R E; Smithson, Emily; Baillie, Sarah; Ferreira, Nuno; Mayr, Ingrid; Power, Michael J

    2013-01-01

    The present study sought to investigate emotion regulation strategies in people with anorexia nervosa (AN) and whether the theoretical concept of 'emotion coupling' between anger and disgust could help to explain some of the specific eating disorder symptomatology in people with AN. This 'emotion coupling' hypothesis was tested using a mood induction procedure within laboratory conditions, where individuals with AN (n = 22) were matched with control participants (n = 19). Participants completed a bank of different measures prior to the study, and these included measures of eating pathology, core beliefs about the self and others, and emotion regulation strategies. Within the experimental part of this study, anger, disgust and body size estimation were measured prior to and after an anger induction procedure (i.e., a repeated measures design). People with AN demonstrated a significantly more internal-dysfunctional way to regulate their emotional states, when compared with matched controls. Within the 'emotional coupling' part of the study, participants showed a significant increase in levels of disgust and body size estimation following an anger induction when compared with matched controls. The significance of these results was considered in the light of the new Schematic, Propositional, Analogical and Associative Representation Systems in eating disorders model. Copyright © 2012 John Wiley & Sons, Ltd.

  20. Factors Associated With Recovery from Anorexia Nervosa

    Science.gov (United States)

    Zerwas, Stephanie; Lund, Brian C.; Holle, Ann Von; Thornton, Laura M.; Berrettini, Wade H.; Brandt, Harry; Crawford, Steven; Fichter, Manfred M.; Halmi, Katherine A.; Johnson, Craig; Kaplan, Allan S.; La Via, Maria; Mitchell, James; Rotondo, Alessandro; Strober, Michael; Woodside, D. Blake; Kaye, Walter H.; Bulik, Cynthia M.

    2013-01-01

    Previous studies of prognostic factors of anorexia nervosa (AN) course and recovery have followed clinical populations after treatment discharge. This retrospective study examined the association between prognostic factors—eating disorder features, personality traits, and psychiatric comorbidity—and likelihood of recovery in a large sample of women with AN participating in a multi-site genetic study. The study included 680 women with AN. Recovery was defined as the offset of AN symptoms if the participant experienced at least one year without any eating disorder symptoms of low weight, dieting, binge eating, and inappropriate compensatory behaviors. Participants completed a structured interview about eating disorders features, psychiatric comorbidity, and self-report measures of personality. Survival analysis was applied to model time to recovery from AN. Cox regression models were used to fit associations between predictors and the probability of recovery. In the final model, likelihood of recovery was significantly predicted by the following prognostic factors: vomiting, impulsivity, and trait anxiety. Self-induced vomiting and greater trait anxiety were negative prognostic factors and predicted lower likelihood of recovery. Greater impulsivity was a positive prognostic factor and predicted greater likelihood of recovery. There was a significant interaction between impulsivity and time; the association between impulsivity and likelihood of recovery decreased as duration of AN increased. The anxiolytic function of some AN behaviors may impede recovery for individuals with greater trait anxiety. PMID:23535032

  1. Visual body perception in anorexia nervosa.

    Science.gov (United States)

    Urgesi, Cosimo; Fornasari, Livia; Perini, Laura; Canalaz, Francesca; Cremaschi, Silvana; Faleschini, Laura; Balestrieri, Matteo; Fabbro, Franco; Aglioti, Salvatore Maria; Brambilla, Paolo

    2012-05-01

    Disturbance of body perception is a central aspect of anorexia nervosa (AN) and several neuroimaging studies have documented structural and functional alterations of occipito-temporal cortices involved in visual body processing. However, it is unclear whether these perceptual deficits involve more basic aspects of others' body perception. A consecutive sample of 15 adolescent patients with AN were compared with a group of 15 age- and gender-matched controls in delayed matching to sample tasks requiring the visual discrimination of the form or of the action of others' body. Patients showed better visual discrimination performance than controls in detail-based processing of body forms but not of body actions, which positively correlated with their increased tendency to convert a signal of punishment into a signal of reinforcement (higher persistence scores). The paradoxical advantage of patients with AN in detail-based body processing may be associated to their tendency to routinely explore body parts as a consequence of their obsessive worries about body appearance. Copyright © 2012 Wiley Periodicals, Inc.

  2. Compulsivity in Anorexia Nervosa: a transdiagnostic concept

    Directory of Open Access Journals (Sweden)

    Lauren Rose Godier

    2014-07-01

    Full Text Available The compulsive nature of weight loss behaviours central to Anorexia Nervosa (AN, such as relentless self-starvation and over-exercise, has led to the suggestion of parallels between AN and other compulsive disorders such as Obsessive-Compulsive Disorder (OCD and addictions. There is a huge unmet need for effective treatments in AN, which has high rates of morbidity and the highest mortality rate of any psychiatric disorder, yet a grave paucity of effective treatments. Viewing compulsivity as a transdiagnostic concept, seen in various manifestations across disorders, may help delineate the mechanisms responsible for the persistence of AN, and aid treatment development. We explore models of compulsivity that suggest dysfunction in cortico-striatal circuitry underpins compulsive behaviour, and consider evidence of aberrances in this circuitry across disorders. Excessive habit formation is considered as a mechanism by which initially rewarding weight loss behaviour in AN may become compulsive over time, and the complex balance between positive and negative reinforcement in this process is considered. The physiological effects of starvation in promoting compulsivity, positive reinforcement and habit formation are also discussed. Further research in AN may benefit from a focus on processes potentially underlying the development of compulsivity, such as aberrant reward processing and habit formation. We discuss the implications of a transdiagnostic perspective on compulsivity, and how it may contribute to the development of novel treatments for AN.

  3. Food motivation circuitry hypoactivation related to hedonic and nonhedonic aspects of hunger and satiety in women with active anorexia nervosa and weight-restored women with anorexia nervosa.

    Science.gov (United States)

    Holsen, Laura M; Lawson, Elizabeth A; Blum, Justine; Ko, Eunice; Makris, Nikos; Fazeli, Pouneh K; Klibanski, Anne; Goldstein, Jill M

    2012-09-01

    Previous studies have provided evidence of food motivation circuitry dysfunction in individuals with anorexia nervosa. However, methodological limitations present challenges to the development of a cohesive neurobiological model of anorexia nervosa. Our goal was to investigate the neural circuitry of appetite dysregulation across states of hunger and satiety in active and weight-restored phases of anorexia nervosa using robust methodology to advance our understanding of potential neural circuitry abnormalities related to hedonic and nonhedonic state and trait. We scanned women with active anorexia nervosa, weight-restored women with anorexia nervosa and healthy-weight controls on a 3-T Siemens magnetic resonance scanner while they viewed images of high- and low-calorie foods and objects before (premeal) and after (postmeal) eating a 400 kcal meal. We enrolled 12 women with active disease, 10 weight-restored women with anorexia nervosa and 11 controls in our study. Compared with controls, both weight-restored women and those with active disease demonstrated hypoactivity premeal in the hypothalamus, amygdala and anterior insula in response to high-calorie foods (v. objects). Postmeal, hypoactivation in the anterior insula persisted in women with active disease. Percent signal change in the anterior insula was positively correlated with food stimuli ratings and hedonic and nonhedonic appetite ratings in controls, but not women with active disease. Our findings are limited by a relatively small sample size, which prevented the use of an analysis of variance model and exploration of interaction effects, although our substantial effect sizes of between-group differences suggest adequate power for our statistical analysis approach. Participants taking psychotropic medications were included. Our data provide evidence of potential state and trait hypoactivations in food motivation regions involved in the assessment of food's reward value and integration of these with

  4. Remission of anorexia nervosa after thyroidectomy: A report of two cases with Graves' disease and anorexia nervosa

    Directory of Open Access Journals (Sweden)

    Noguchi Hitoshi

    2011-12-01

    Full Text Available Abstract We report two patients with anorexia nervosa and Graves' disease who received subtotal thyroidectomy for Graves' disease and concomitantly experienced remission from anorexia nervosa. Both were young women (aged 20 and 26 at the time of surgery. Both had well controlled thyroid function and eating behavior at the time of surgery. Both were followed for over five years without relapse of anorexia nervosa or hyperthyroidism. These cases suggest the existence of an endocrine factor originating from the thyroid gland that is involved in the pathogenesis of anorexia nervosa. Since patients of thyroidectomy can remain in good health with supplement of thyroxine alone, it can be hypothesized that this anorexigenic endocrine factor is an evolutionary relic not necessary for the normal function of humans and does not have physiological effects unless secreted beyond normal levels. Given that, it implies the existence of a creature in the animal kingdom for which such an anorexigenic hormone is essential for survival. Migrating birds eat beyond their caloric expenditure before migration and become anorexic for the duration of their flight. It is also known that their thyroid function is elevated during migration. The normal physiology of migration is a complex mechanism involving the hypothalamic, pituitary, thyroid, adrenal and reproductive hormones. The mechanism of disease, however, can be simpler. A review of the literature is presented that suggest a heretofore unreported thyroid hormone, which is involved in the regulation of migration behavior, may be the responsible factor behind anorexia nervosa.

  5. Participatory action research for women with anorexia nervosa.

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    Nicholls, Daniel; Fogarty, Sarah; Hay, Phillipa; Ramjan, Lucie Michelle

    2016-05-01

    To discuss the application of the principles of participatory action research (PAR) in a project that developed and evaluated a mentor-mentee support programme for women with anorexia nervosa. A programme was developed and implemented in which mentors and mentees participated in workshops, social activities and focus groups that sought to support and develop resilience for those experiencing anorexia nervosa. PAR principles were mirrored in the programme, paying respect to the views and needs of each participant, an open trajectory to possible conclusions and a continuous feedback cycle. Mentees had a sense of empowerment, ownership of the programme and hope that recovery was possible. It allowed their voices to be heard and provided them with belief they could begin new relationships and friendships. The principles of PAR suited a project aimed at developing self-determination and resilience in women with anorexia nervosa. PAR would be readily transferable to a number of mental health settings where empowerment is of paramount concern.

  6. Emotional functioning in anorexia nervosa patients: adolescents compared to adults.

    Science.gov (United States)

    Zonnevylle-Bender, Marjo J S; van Goozen, Stephanie H M; Cohen-Kettenis, Peggy T; van Elburg, Annemarie; de Wildt, Martin; Stevelmans, Elis; van Engeland, Herman

    2004-01-01

    Studies concerning eating disorder patients have revealed the presence of alexithymia, depressive, and anxiety disorders. We compared these aspects of emotional functioning in two groups of anorexia nervosa (AN) patients: adolescents vs. adults. Forty-eight adolescent anorexia nervosa patients (ADO) and 23 adult anorexia nervosa patients (ADU) completed a battery of tasks and questionnaires to measure these different aspects of emotional functioning and to control for differences of a more general cognitive nature. Both groups showed marked resemblance; both had high alexithymia scores and performed worse on emotional tasks measuring aspects of alexithymia. Furthermore, both groups showed high percentages of depressive and anxiety disorders, with the ADU group scoring only higher on specific and social phobia than the ADO group. Adult and adolescent AN patient groups do not differ substantially with respect to emotional functioning. Copyright 2004 Wiley-Liss, Inc.

  7. Mindfulness in Anorexia Nervosa: An Integrated Review of the Literature.

    Science.gov (United States)

    Dunne, Julie

    Anorexia nervosa is a serious psychiatric illness with limited evidenced-based treatment options. Mindfulness appears useful in many conditions, but few studies focus on its use in individuals with anorexia nervosa. To examine and summarize studies of mindfulness in individuals with anorexia nervosa and identify areas for future research. An integrated review was conducted by searching health care computerized databases. Results were mixed among the eight studies that met inclusion criteria. Multimodal mindfulness-based therapies appear effective, while brief interventions may be equally useful or result in greater anxiety compared to distraction. Qualitative data support that some participants feel mindfulness is challenging but beneficial. Mindfulness as a concurrent part of therapy and/or when routinely practiced may be more clinically useful than single-episode mindful eating interventions. Due to the complexity of the concept of mindfulness and limited existing data, additional research is needed.

  8. Association of Elevated Reward Prediction Error Response With Weight Gain in Adolescent Anorexia Nervosa.

    Science.gov (United States)

    DeGuzman, Marisa; Shott, Megan E; Yang, Tony T; Riederer, Justin; Frank, Guido K W

    2017-06-01

    Anorexia nervosa is a psychiatric disorder of unknown etiology. Understanding associations between behavior and neurobiology is important in treatment development. Using a novel monetary reward task during functional magnetic resonance brain imaging, the authors tested how brain reward learning in adolescent anorexia nervosa changes with weight restoration. Female adolescents with anorexia nervosa (N=21; mean age, 16.4 years [SD=1.9]) underwent functional MRI (fMRI) before and after treatment; similarly, healthy female control adolescents (N=21; mean age, 15.2 years [SD=2.4]) underwent fMRI on two occasions. Brain function was tested using the reward prediction error construct, a computational model for reward receipt and omission related to motivation and neural dopamine responsiveness. Compared with the control group, the anorexia nervosa group exhibited greater brain response 1) for prediction error regression within the caudate, ventral caudate/nucleus accumbens, and anterior and posterior insula, 2) to unexpected reward receipt in the anterior and posterior insula, and 3) to unexpected reward omission in the caudate body. Prediction error and unexpected reward omission response tended to normalize with treatment, while unexpected reward receipt response remained significantly elevated. Greater caudate prediction error response when underweight was associated with lower weight gain during treatment. Punishment sensitivity correlated positively with ventral caudate prediction error response. Reward system responsiveness is elevated in adolescent anorexia nervosa when underweight and after weight restoration. Heightened prediction error activity in brain reward regions may represent a phenotype of adolescent anorexia nervosa that does not respond well to treatment. Prediction error response could be a neurobiological marker of illness severity that can indicate individual treatment needs.

  9. Clinical and genetic correlates of decision making in anorexia nervosa.

    Science.gov (United States)

    Tenconi, Elena; Degortes, Daniela; Clementi, Maurizio; Collantoni, Enrico; Pinato, Claudia; Forzan, Monica; Cassina, Matteo; Santonastaso, Paolo; Favaro, Angela

    2016-01-01

    Decision-making (DM) abilities have been found to be impaired in anorexia nervosa (AN), but few data are available about the characteristics and correlates of this cognitive function. The aim of the present study was to provide data on DM functioning in AN using both veridical and adaptive paradigms. While in veridical DM tasks, the individual's ability to predict a true/false response is measured, adaptive DM is the ability to consider both internal and external demands in order to make a good choice, in the absence of a single true "correct" answer. The participants were 189 women, of whom 91 were eating-disordered patients with a lifetime diagnosis of anorexia nervosa, and 98 were healthy women. All the participants underwent clinical, neuropsychological, and genetic assessment. The cognitive evaluation included a set of neuropsychological tasks and two decision-making tests: The Iowa Gambling Task and the Cognitive Bias Task. Anorexia nervosa patients showed significantly poorer performances on both decision-making tasks than healthy women. The Cognitive Bias Task revealed that anorexia nervosa patients employed significantly more context-independent decision-making strategies, which were independent from diagnostic subtype, handedness, education, and psychopathology. In the whole sample (patients and controls), Cognitive Bias Task performance was independently predicted by lifetime anorexia nervosa diagnosis, body mass index at assessment, and 5-HTTLPR genotype. Patients displayed poor decision-making functioning in both veridical and adaptive situations. The difficulties detected in anorexia nervosa individuals may affect not only the ability to consider the future outcomes of their actions (leading to "myopia for the future"), but also the capacity to update and review one's own mindset according to new environmental stimuli.

  10. Psychopharmacotherapy of anorexia nervosa, bulimia nervosa and binge-eating disorder

    Science.gov (United States)

    Kruger, S; Kennedy, SH

    2000-01-01

    Pharmacotherapy for anorexia nervosa is considered to be of limited efficacy. However, many studies suffer methodological limitations, and the utility of newer drugs in the treatment of anorexia has not been examined yet. Although there have been more fruitful investigations on the efficacy of medication in the management of bulimia nervosa, there are still many unresolved issues regarding the optimal management of partial remission during the acute treatment phase and the intensity and duration of pharmacotherapy to achieve optimal prophylaxis. Selective serotonin reuptake inhibitors (SSRIs) control the binge urges in binge-eating disorder, but more trials are required to investigate the utility of SSRIs and other agents in maintenance treatment. We review the current status of psychopharmacotherapy for anorexia nervosa, bulimia nervosa and binge-eating disorder and evaluate the merits of newer agents in the treatment of these disorders. PMID:11109300

  11. Eating disorders focused on anorexia and bulimia nervosa.

    OpenAIRE

    Zinková, Alžběta

    2011-01-01

    The study deals with eating disorders. It tries to bring the most comprehensive overview of the two majority eating disorders, anorexia nervosa and bulimia nervosa, respectively. Both diseases have a lot in common, but also some of its specifics which are pointed out in the study. The study is conceived to make the reader in the early chapters acquainted with the various eating disorders according to international diagnostic criteria. Then there is a brief history, epidemiology and etiology a...

  12. Psychopathology and psychotherapy in adolescents with anorexia and bulimia nervosa

    OpenAIRE

    Salbach-Andrae, Harriet

    2010-01-01

    Anorexia nervosa (AN) and bulimia nervosa (BN) are multifactorial diseases, which are among the most prevalent disorders in child and adolescent psychiatry. Aesthetic sports are often considered as a risk factor for the development of an eating disorder. The present professorial dissertation for the first time demonstrates no higher risk for competitive athletes aged 12 to 18 years to develop an eating disorder. Research shows that psychiatric comorbidity is a very unfavorable prognostic ...

  13. [Follow-up and treatment outcome of early anorexia nervosa].

    Science.gov (United States)

    Schulze, U; Neudörfl, A; Krill, A; Warnke, A; Remschmidt, H; Herpertz-Dahlmann, B

    1997-03-01

    In a two-center follow-up study on the early-onset form of anorexia nervosa, we reexamined 43 (74%) of 58 former patients who had developed anorexia nervosa at the age of 13 years or younger. In addition to make a standardized assessment of the eating disorder at follow-up we assessed psychiatric comorbidity with a structured interview based on the criteria of DSM-III-R and ICD-10. After an average follow-up period of 6.8 years, 8 (18%) of our former patients had an eating disorder not otherwise specified (EDNOS) and 4 (9%) still suffered from anorexia nervosa. 5 (11%) of the subjects had developed bulimia nervosa. In 3 cases (7%) we found both syndromes. 12 (28%) of our former patients had an additional psychiatric disorder. The results of our study indicate that the quality of outcome in patients with an early-onset form of anorexia nervosa does not differ from that in individuals with a later manifestation of the eating disorder. Factors of prognostic relevance were the existence of an eating disorder during the first year of life and the duration of the follow-up period.

  14. Early-onset anorexia nervosa in girls with Asperger syndrome

    Directory of Open Access Journals (Sweden)

    Dudova I

    2015-07-01

    Full Text Available Iva Dudova, Jana Kocourkova, Jiri Koutek Department of Child Psychiatry, Charles University Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic Abstract: Eating disorders frequently occur in conjunction with autism spectrum disorders, posing diagnostic and therapeutic difficulties. The comorbidity of anorexia nervosa and Asperger syndrome is a significant clinical complication and has been associated with a poorer prognosis. The authors are presenting the cases of an eleven-year-old girl and a five-and-a-half-year-old girl with comorbid eating disorders and Asperger syndrome. Keywords: eating disorders, early-onset anorexia nervosa, autism spectrum disorders, Asperger syndrome, diagnostics, therapy

  15. Appetite regulatory hormones in women with anorexia nervosa: binge-eating/purging versus restricting type.

    Science.gov (United States)

    Eddy, Kamryn T; Lawson, Elizabeth A; Meade, Christina; Meenaghan, Erinne; Horton, Sarah E; Misra, Madhusmita; Klibanski, Anne; Miller, Karen K

    2015-01-01

    Anorexia nervosa is a psychiatric illness characterized by low weight, disordered eating, and hallmark neuroendocrine dysfunction. Behavioral phenotypes are defined by predominant restriction or bingeing/purging; binge-eating/purging type anorexia nervosa is associated with poorer outcome. The pathophysiology underlying anorexia nervosa types is unknown, but altered hormones, known to be involved in eating behaviors, may play a role. To examine the role of anorexigenic hormones in anorexia nervosa subtypes, we examined serum levels of peptide YY (PYY; total and active [3-36] forms), brain-derived neurotrophic factor (BDNF), and leptin as primary outcomes in women with DSM-5 restricting type anorexia nervosa (n = 50), binge-eating/purging type anorexia nervosa (n = 25), and healthy controls (n = 22). In addition, women completed validated secondary outcome measures of eating disorder psychopathology (Eating Disorder Examination-Questionnaire) and depression and anxiety symptoms (Hamilton Rating Scales for Depression [HDRS] and Anxiety [HARS]). The study samples were collected from May 22, 2004, to February 7, 2012. Mean PYY 3-36 and leptin levels were lower and BDNF levels higher in binge-eating/purging type anorexia nervosa than in restricting type anorexia nervosa (all P values anorexia nervosa types were significant (P anorexia nervosa, the anorexigenic hormones PYY, BDNF, and leptin are differentially regulated between the restricting and binge/purge types. Whether these hormone pathways play etiologic roles with regard to anorexia nervosa behavioral types or are compensatory merits further study. © Copyright 2015 Physicians Postgraduate Press, Inc.

  16. Comorbid Depression and Anxiety in Childhood and Adolescent Anorexia Nervosa: Prevalence and Implications for Outcome

    Science.gov (United States)

    Hughes, Elizabeth K.

    2012-01-01

    Background: Comorbid conditions are common in individuals with anorexia nervosa (AN) and can raise issues for diagnosis, prognosis, and treatment planning. Methods: First, reported prevalence rates for depression and anxiety in children and adolescents with AN were reviewed. Diagnostic issues and current understanding of the temporal onset and…

  17. Anorexia nervosa: treatment expectations – a qualitative study

    Science.gov (United States)

    Paulson-Karlsson, Gunilla; Nevonen, Lauri

    2012-01-01

    Background Anorexia nervosa is a serious illness with a high mortality rate, a poor outcome, and no empirically supported treatment of choice for adults. Patients with anorexia nervosa strive for thinness in order to obtain self-control and are ambivalent toward change and toward treatment. In order to achieve a greater understanding of patients’ own understanding of their situation, the aim of this study was to examine the expectations of potential anorexic patients seeking treatment at a specialized eating-disorder unit. Methods A qualitative study design was used. It comprised 15 women between 18 and 25 years of age waiting to be assessed before treatment. The initial question was, “What do you expect, now that you are on the waiting list for a specialized eating-disorder unit?” A content analysis was used, and the text was coded, categorized according to its content, and further interpreted into a theme. Results From the results emerged three main categories of what participants expected: “treatment content,” “treatment professionals,” and “treatment focus.” The overall theme, “receiving adequate therapy in a collaborative therapeutic relationship and recovering,” described how the participants perceived that their expectations could be fulfilled. Discussion Patients’ expectations concerning distorted thoughts, eating behaviors, a normal, healthy life, and meeting with a professional with knowledge and experience of eating disorders should be discussed before treatment starts. In the process of the therapeutic relationship, it is essential to continually address patients’ motivations, in order to understand their personal motives behind what drives their expectations and their desire to recover. PMID:22888259

  18. Gait analysis in anorexia and bulimia nervosa.

    Science.gov (United States)

    Cimolin, Veronica; Galli, Manuela; Vismara, Luca; Vimercati, Sara Laura; Precilios, Helmer; Cattani, Laila; Fabris De Souza, Shirley; Petroni, Maria Letizia; Capodaglio, Paolo

    2013-09-13

    Anorexia (AN) and Bulimia Nervosa (BN) are two common eating disorders, which appear to share some reduced motor capacities, such as a reduced balance. The presence and the extent of other motor disorders have not been investigated in a comprehensive way. The aim of this study was to quantify gait pattern in AN and BN individuals in order to ascertain possible differences from the normality range and provide novel data for developing some evidence-based rehabilitation strategies. Nineteen AN patients (age 30.16+9.73) and 20 BN patients (age 26.8+8.41) were assessed with quantitative 3D computerized Gait Analysis. Results were compared with a group of healthy controls (CG; 30.7+5.6). AN and BN patients were characterized by different gait strategies compared to CG. Spatio-temporal parameters indicated shorter step length, with AN showing the shortest values. AN walked slower than BN and CG. As for kinematics, AN and BN showed a nonphysiologic pattern at pelvis and hip level on the sagittal and frontal plane, with BN yielding the most abnormal values. Both AN and BN patients were characterized by high ankle plantar flexion capacity at toe-off when compared to CG. As for ankle kinetics, both AN and BN showed physiologic patterns. Stiffness at hip level was close to CG in both pathologic groups; at the ankle level, stiffness was significantly decreased in both groups, with AN displaying lower values. Both AN and BN were characterized by an altered gait pattern compared to CG. Biomechanical differences were evident mainly at pelvis and hip level. Loss of lean mass may lead to musculoskeletal adaptation, ultimately causing alterations in the gait pattern.

  19. A Case Study of Anorexia Nervosa Driven by Religious Sacrifice

    Directory of Open Access Journals (Sweden)

    Amelia A. Davis

    2014-01-01

    Full Text Available Anorexia nervosa (AN is considered a relatively “modern” disorder; however, a number of scholarly works have cited examples of voluntary self-starvation dating back to several centuries. In particular, there are many examples of female starvation for religious reasons during the medieval period, with many being elevated to sainthood. We present a case of an elderly woman with AN who began restricting her diet when she was 13-years old while studying to be a nun at a Catholic convent. She reports that, during the development of her disease, she had no mirrors and, rather than restricting her diet to be thin or attractive, she restricted her diet to be closer to God in hopes of becoming a Saint. This unique case presents an opportunity to deepen our understanding of AN and the cultural context that affects its development.

  20. Emotion-focused therapy in a case of anorexia nervosa.

    Science.gov (United States)

    Dolhanty, Joanne; Greenberg, Leslie S

    2009-01-01

    An emotion-focused approach to the treatment of eating disorders and to case formulation is described in an individual with anorexia nervosa (AN). The basic theory of emotion-focused therapy (EFT), the steps of case formulation and an outline of the tasks and course of treatment of an individual recently hospitalized on an inpatient unit for eating disorders highlight key aspects of the approach. The transformation in this individual, in terms of gaining access to her internal experience, understanding and tolerating her emotions, and working through her core themes of insecure attachment and worthlessness, is described. Weight and scores on self-report measures at the outset of treatment and at 18 months are provided.

  1. Childhood trauma and anorexia nervosa: From body image to embodiment.

    Science.gov (United States)

    Malecki, Jennifer; Rhodes, Paul; Ussher, Jane

    2018-02-27

    Contemporary understandings of anorexia nervosa are framed by the body image paradigm. The body-image framework considers that women's bodily experiences are reflected through distorted mental images of their bodies or disordered thinking and behavior around food and eating. Body image has come to symbolize all that can go wrong with women's relationship with their bodies, food and eating. The problem with this approach is its failure to consider the experience of women who survived childhood abuse. Women's bodily disturbances are not easily discernible through objective measures as they lie within the inner subjective realm of the embodied 'self', and embodied emotional experience. Consideration of the different ways that women inhabit their bodies inform this paper's examination of the conceptual framework embodiment as an alternate to the body image paradigm.

  2. The role of pride in women with anorexia nervosa: A grounded theory study.

    Science.gov (United States)

    Faija, Cintia L; Tierney, Stephanie; Gooding, Patricia A; Peters, Sarah; Fox, John R E

    2017-12-01

    Theory and clinical literature suggest that pride may play an important role in the maintenance of restrictive eating disorders. A grounded theory study explored experiences of, and reflections on, pride among women with a current or past diagnosis of anorexia nervosa. This is a qualitative study using grounded theory. Semistructured interviews were conducted with 21 women recruited from an eating disorder unit in England, and from a UK self-help organization. Grounded theory from a constructivist lens was used. Analysis involved coding, constant comparison, and memo-writing. Pride evolves over the course of anorexia nervosa. Two overarching conceptual categories were identified: 'pride becoming intertwined with anorexia' and 'pride during the journey towards recovery'. These categories encompassed different forms of pride: 'alluring pride', 'toxic pride', 'pathological pride', 'anorexia pride', 'shameful pride', 'recovery pride', and 'resilient pride'. Initially, pride contributed to self-enhancement and buffered negative emotions. As the condition progressed, pride became a challenge to health and interfered with motivation to change. During recovery, perceptions of pride altered as a healthy approach to living ensued. The evolving nature of pride plays a central role in development, maintenance, and treatment of anorexia nervosa. Understanding of pride and its role in psychotherapeutic work with this client group may increase motivation to change and promote recovery. Future work should investigate whether tackling pride in eating disorders increases treatment efficacy and reduces the risk of relapsing. Pride associated with anorexia appeared to evolve in nature. During early stages of the eating disorder, it stopped people from seeking help. Later on, it prevented them from seeing pride in healthy domains of life (outside anorexia). Over time, pride in anorexia became an overwhelming emotion that interfered with motivation to change. It is important for

  3. Osteopenia and bone fractures in a man with anorexia nervosa and hypogonadism

    International Nuclear Information System (INIS)

    Rigotti, N.A.; Neer, R.M.; Jameson, L.

    1986-01-01

    Women with anorexia nervosa have reduced skeletal mass. Both anorexia and osteopenia are less common in men. We describe a 22-year-old man with anorexia nervosa and severe osteopenia involving both cortical and trabecular bone who developed a pelvic fracture and multiple vertebral compression fractures. He was found to have secondary hypogonadotropic hypogonadism that was reversible with weight gain. This case illustrates the need to consider osteopenia as a potential complication of anorexia nervosa in males as well as females

  4. Osteopenia and bone fractures in a man with anorexia nervosa and hypogonadism

    Energy Technology Data Exchange (ETDEWEB)

    Rigotti, N.A.; Neer, R.M.; Jameson, L.

    1986-07-18

    Women with anorexia nervosa have reduced skeletal mass. Both anorexia and osteopenia are less common in men. We describe a 22-year-old man with anorexia nervosa and severe osteopenia involving both cortical and trabecular bone who developed a pelvic fracture and multiple vertebral compression fractures. He was found to have secondary hypogonadotropic hypogonadism that was reversible with weight gain. This case illustrates the need to consider osteopenia as a potential complication of anorexia nervosa in males as well as females.

  5. Appetite Regulatory Hormones in Women With Anorexia Nervosa: Binge-Eating/Purging Versus Restricting Type

    Science.gov (United States)

    Eddy, Kamryn T.; Lawson, Elizabeth A.; Meade, Christina; Meenaghan, Erinne; Horton, Sarah E.; Misra, Madhusmita; Klibanski, Anne; Miller, Karen K.

    2015-01-01

    Objective Anorexia nervosa is a psychiatric illness characterized by low weight, disordered eating, and hallmark neuroendocrine dysfunction. Behavioral phenotypes are defined by predominant restriction or bingeing/purging; binge-eating/purging type anorexia nervosa is associated with poorer outcome. The pathophysiology underlying anorexia nervosa types is unknown, but altered hormones, known to be involved in eating behaviors, may play a role. Method To examine the role of anorexigenic hormones in anorexia nervosa subtypes, we examined serum levels of peptide YY (PYY; total and active [3-36] forms), brain-derived neurotrophic factor (BDNF), and leptin as primary outcomes in women with OSM-5 restricting type anorexia nervosa (n=50), binge-eating/purging type anorexia nervosa (n = 22), and healthy controls (n = 22).1n addition, women completed validated secondary outcome measures of eating disorder psychopathology (Eating Disorder Examination-Questionnaire) and depression and anxiety symptoms (Hamilton Rating Scales for Depression [HDRS] and Anxiety [HARS]). The study samples were collected from May 22, 2004, to February 7, 2012. Results Mean PYY 3-36 and leptin levels were lower and BDNF levels higher in binge-eating/purging type anorexia nervosa than in restricting type anorexia nervosa (all Pvalues anorexia nervosa types were significant (Panorexia nervosa, the anorexigenic hormones PYY, BDNF, and leptin are differentially regulated between the restricting and binge/purge types. Whether these hormone pathways play etiologic roles with regard to anorexia nervosa behavioral types or are compensatory merits further study. PMID:25098834

  6. Taste Reward Circuitry Related Brain Structures Characterize Ill and Recovered Anorexia Nervosa and Bulimia Nervosa

    Science.gov (United States)

    Frank, Guido K.; Shott, Megan E.; Hagman, Jennifer O.; Mittal, Vijay A.

    2013-01-01

    Objective The pathophysiology of the eating disorder anorexia nervosa remains obscure, but structural brain alterations could be functionally important biomarkers. Here we assessed taste pleasantness and reward sensitivity in relation to brain structure, which might be related to food avoidance commonly seen in eating disorders. Method We used structural magnetic resonance brain imaging to study gray and white matter volumes in individuals with restricting type currently ill (n = 19) or recovered-anorexia nervosa (n = 24), bulimia nervosa (n= 19) and healthy control women (n=24). Results All eating disorder groups showed increased gray matter volume of the medial orbitofrontal cortex (gyrus rectus). Manually tracing confirmed larger gyrus rectus volume, and predicted taste pleasantness across all groups. The analyses also indicated other morphological differences between diagnostic categories: Ill and recovered-anorexia nervosa had increased right, while bulimia nervosa had increased left antero-ventral insula gray matter volumes compared to controls. Furthermore, dorsal striatum volumes were reduced in recovered-anorexia and bulimia nervosa, and predicted sensitivity to reward in the eating disorder groups. The eating disorder groups also showed reduced white matter in right temporal and parietal areas when compared to healthy controls. Notably, the results held when controlling for a range of covariates (e.g., age, depression, anxiety, medications). Conclusion Brain structure in medial orbitofrontal cortex, insula and striatum is altered in eating disorders and suggests altered brain circuitry that has been associated with taste pleasantness and reward value. PMID:23680873

  7. The role of body image and self-perception in anorexia nervosa: the neuroimaging perspective.

    Science.gov (United States)

    Esposito, Roberto; Cieri, Filippo; di Giannantonio, Massimo; Tartaro, Armando

    2018-03-01

    Anorexia nervosa is a severe psychiatric illness characterized by intense fear of gaining weight, relentless pursuit of thinness, deep concerns about food and a pervasive disturbance of body image. Functional magnetic resonance imaging tries to shed light on the neurobiological underpinnings of anorexia nervosa. This review aims to evaluate the empirical neuroimaging literature about self-perception in anorexia nervosa. This narrative review summarizes a number of task-based and resting-state functional magnetic resonance imaging studies in anorexia nervosa about body image and self-perception. The articles listed in references were searched using electronic databases (PubMed and Google Scholar) from 1990 to February 2016 using specific key words. All studies were reviewed with regard to their quality and eligibility for the review. Differences in brain activity were observed using body image perception and body size estimation tasks showing significant modifications in activity of specific brain areas (extrastriate body area, fusiform body area, inferior parietal lobule). Recent studies highlighted the role of emotions and self-perception in anorexia nervosa and their neural substrate involving resting-state networks and particularly frontal and posterior midline cortical structures within default mode network and insula. These findings open new horizons to understand the neural substrate of anorexia nervosa. © 2016 The British Psychological Society.

  8. Anorexia nervosa: the diagnosis. A postmodern ethics contribution to the bioethics debate on involuntary treatment for anorexia nervosa.

    Science.gov (United States)

    Kendall, Sacha

    2014-03-01

    This paper argues that there is a relationship between understandings of anorexia nervosa (AN) and how the ethical issues associated with involuntary treatment for AN are identified, framed, and addressed. By positioning AN as a construct/discourse (hereinafter "AN: the diagnosis") several ethical issues are revealed. Firstly, "AN: the diagnosis" influences how the autonomy and competence of persons diagnosed with AN are understood by decision-makers in the treatment environment. Secondly, "AN: the diagnosis" impacts on how treatment and treatment efficacy are defined and the ethical justifiability of paternalism. Thirdly, "AN: the diagnosis" can limit the opportunity for persons with AN to construct an identity that casts them as a competent person. "AN: the diagnosis" can thus inherently affirm professional knowledge and values. Postmodern professional ethics can support professionals in managing these issues by highlighting the importance of taking responsibility for professional knowledge, values, and power and embracing moral uncertainty.

  9. Perceived Personality Traits of Individuals with Anorexia Nervosa

    Science.gov (United States)

    Watters, Jessica E.; Malouff, John M.

    2012-01-01

    Background: Prior research has found evidence of a general negative personality stereotype for individuals who have anorexia nervosa (AN). Methods: This study examined the expected personality characteristics of individuals with AN using the Five-Factor Model of personality to allow identification of specific personality traits that are part of…

  10. Anorexia nervosa in Kenya | Njenga | East African Medical Journal

    African Journals Online (AJOL)

    Background: Anorexia nervosa is a rare disorder in Africans, inspite of posing a serious public health hazard in the West. Whereas it is possible that African psychiatrists lack the skills to diagnose the disorder, other possible explanations for its apparent rarity must be sought in view of emerging evidence, which suggests a ...

  11. The Impact of Childhood Sexual Abuse in Anorexia Nervosa

    Science.gov (United States)

    Carter, Jacqueline C.; Bewell, Carmen; Blackmore, Elizabeth; Woodside, D. Blake

    2006-01-01

    Objective: The aim of this study was to examine the impact of childhood sexual abuse (CSA) on clinical characteristics and premature termination of treatment in anorexia nervosa (AN). Method: The participants were 77 consecutive patients with AN admitted to an inpatient eating disorders unit. The patients were assessed in terms of eating disorder…

  12. Drive for activity in patients with anorexia nervosa

    NARCIS (Netherlands)

    Sternheim, Lot; Danner, Unna; Adan, Roger; van Elburg, Annemarie

    2014-01-01

    OBJECTIVE: Hyperactivity and elevated physical activity are both considered symptom characteristics of anorexia nervosa (AN). It has been suggested that a drive for activity (DFA) may underlie these expressions, yet research into DFA in AN remains scant. This study investigated DFA levels in

  13. Drive for activity in patients with anorexia nervosa

    NARCIS (Netherlands)

    Sternheim, Lot; Danner, Unna; Adan, Roger; Van Elburg, Annemarie

    2015-01-01

    Method Two hundred and forty female patients with AN completed measures for DFA, eating disorder (ED) pathology, anxiety, and clinical parameters. Objective Hyperactivity and elevated physical activity are both considered symptom characteristics of anorexia nervosa (AN). It has been suggested that a

  14. The role of pharmacotherapy in anorexia nervosa and bulimia.

    Science.gov (United States)

    Tolstoi, L G

    1989-11-01

    The purpose of this article is to review the basic pharmacology and the role of drugs that are used to treat anorexia nervosa and bulimia. The pharmacological treatment of eating disorders is based upon theoretical principles. The theoretical models include: (a) an illness secondary to other psychiatric disorders, (b) a disorder in the hypothalamic control of food intake, (c) a disorder of hypothalamic endocrine regulation, (d) a syndrome secondary to depressive illness, and (e) a disorder in the hypothalamic regulation of food intake. Theoretical models a, b, and c govern the choice of drug therapy for anorexia nervosa, and models d and e govern the choice of drug therapy for bulimia. Drugs used to treat anorexia nervosa and bulimia include tricyclic antidepressants and lithium carbonate. Chlorpromazine, metoclopramide, cyproheptadine, and clomiphene citrate have also been prescribed for the treatment of anorexia nervosa. Monoamine oxidase inhibitors are commonly prescribed to treat bulimia. Fenfluramine has the potential to be of therapeutic value in patients with bulimia. Although drug therapy plays a limited role in the treatment of eating disorders, drugs are commonly prescribed. Therefore, the nutritionist should be familiar with the basic pharmacology and the side effects related to drug therapy.

  15. Heightened attentional capture by visual food stimuli in Anorexia Nervosa

    NARCIS (Netherlands)

    Neimeijer, Renate A.M.; Roefs, Anne; de Jong, Peter J.

    2017-01-01

    The present study was designed to test the hypothesis that anorexia nervosa (AN) patients are relatively insensitive to the attentional capture of visual food stimuli. Attentional avoidance of food might help AN patients to prevent more elaborate processing of food stimuli and the subsequent

  16. Directives in anorexia nervosa: use of the "Ulysses Agreement".

    Science.gov (United States)

    Davidson, H; Birmingham, C L

    2003-09-01

    The course of anorexia nervosa frequently has episodes of exacerbation during which motivation and insight are reduced, cognition is impaired and treatment resistance is increased. Formalizing a directive to be used during these episodes when the patient has greater motivation and insight is one way of reducing treatment resistance. We describe a form of directive, called the "Ulysses Agreement".

  17. [Neurofeedback in the Treatment of Anorexia Nervosa: a Case Report].

    Science.gov (United States)

    Lackner, N; Unterrainer, H F; Skliris, D; Wood, G; Dunitz-Scheer, M; Wallner-Liebmann, S J; Scheer, P J Z; Neuper, C

    2016-02-01

    Anorexia nervosa has been related to alterations in brain activity in terms of hyperactive EEG patterns. This case report illustrates the principles and results of a five-week neurofeedback treatment in a 29-year-old woman suffering from anorexia nervosa. A neurofeedback protocol to enhance alpha activity (8 - 12 Hz) was developed and conducted additionally to the standardized treatment for eating disorders in training sessions twice a week. Pre- and post-test measurements included resting state EEG measurements and a psychological test battery. The results show improvements from pre- to post-test in eating disorder psychopathology including psychological wellbeing, emotional competence, and eating behavior traits. In addition, a decrease in theta power (4 - 7 Hz), a well-known trait marker of anorexia nervosa, was measured. However, our data should be interpreted with caution because this is a single case study. Nevertheless, this report documents the practicability and method of neurofeedback as treatment adjunct in eating disorders from the clinical perspective. Although the use of neurofeedback in the treatment of anorexia nervosa is recommended in literature, empirical studies are still lacking. Randomized controlled trials to evaluate short- and long-term effects of neurofeedback are needed. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Psychoneuroendocrinological aspects of anorexia nervosa: predictors of recovery

    NARCIS (Netherlands)

    Elburg, A.A. van

    2007-01-01

    Anorexia Nervosa (AN) is a psychosomatic eating disorder of unknown aetiology, which primarily affects adolescent girls and young women and is characterized by aberrant patterns of eating behaviour and weight regulation which result in weight loss and endocrine abnormalities such as amenorrhea,

  19. Long-term outcome in anorexia nervosa in the community

    NARCIS (Netherlands)

    Mustelin, Linda; Raevuori, Anu; Bulik, Cynthia M.; Rissanen, Aila; Hoek, Hans W.; Kaprio, Jaakko; Keski-Rahkonen, Anna

    2015-01-01

    ObjectiveFew studies have assessed outcomes of anorexia nervosa (AN) outside clinical settings. We aimed to assess mortality, recovery, and socio-demographic outcomes of AN in a community sample. MethodWomen in the nationwide FinnTwin16 cohort (born 1975-1979) were followed for 10 years after

  20. Anorexia Nervosa: An Overview for the School Counselor.

    Science.gov (United States)

    Nufrio, Ronald M.

    Anorexia nervosa is a serious eating disorder which affects thousands of people every year. Ninety-five percent of all anorexics are females with the peak age of onset between 14 and 18. While anorexics fit into no specific stereotype, high-risk candidates are often perfectionists and model children who exhibit self-doubt, high conformity,…

  1. An investigation of habit learning in Anorexia Nervosa

    NARCIS (Netherlands)

    Godier, L.R.; de Wit, S.; Pinto, A.; Steinglass, J.E.; Greene, A.L.; Scaife, J.; Gillan, C.M.; Walsh, B.T.; Simpson, H.-B.; Park, R.J.

    2016-01-01

    Anorexia Nervosa (AN) is a disorder characterised by compulsive behaviour, such as self-starvation and excessive exercise, which develop in the pursuit of weight-loss. Recent theory suggests that once established, compulsive weight-loss behaviours in AN may become habitual. In two parallel studies,

  2. Bulimia and Anorexia Nervosa in Dental and Dental Hygiene Curricula.

    Science.gov (United States)

    Gross, Karen B. W.; And Others

    1990-01-01

    Dentists and dental hygienists are in a unique position to identify an eating disorder patient from observed oral manifestations and to refer the patient for psychological therapy. The inclusion of information on general and oral complications of bulimia and anorexia nervosa in dental and dental hygiene curriculum was examined. (MLW)

  3. Heightened sensitivity to punishment and reward in anorexia nervosa

    NARCIS (Netherlands)

    Glashouwer, Klaske A; Bloot, Lotte; Veenstra, Esther M; Franken, Ingmar H A; de Jong, Peter J

    OBJECTIVE: The aim of this study was to investigate reinforcement sensitivity in anorexia nervosa (AN). It was tested whether self-reported punishment (PS) and reward sensitivity (RS) differed between adolescents with AN and healthy controls, and/or between AN-subtypes. In addition, the predictive

  4. Psychiatric Comorbidities among Female Adolescents with Anorexia Nervosa

    Science.gov (United States)

    Salbach-Andrae, Harriet; Lenz, Klaus; Simmendinger, Nicole; Klinkowski, Nora; Lehmkuhl, Ulrike; Pfeiffer, Ernst

    2008-01-01

    This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no…

  5. A Psychoeducational Group Approach for Individuals Recovering from Anorexia Nervosa.

    Science.gov (United States)

    Kapp, Lisa

    Although in-depth, long-term group psychotherapy is a beneficial therapeutic experience for adolescent females suffering from anorexia nervosa, these clients are notoriously resistant to treatment and to long-term, open-ended group settings. This dissidence may stem from a motivational deficiency toward changing their eating patterns and…

  6. The Role of Body Weight on Bone in Anorexia Nervosa

    DEFF Research Database (Denmark)

    Frølich, Jacob; Hansen, Stinus; Winkler, Laura Al-Dakhiel

    2017-01-01

    Anorexia nervosa (AN) is associated with decreased bone mineral density and increased risk of fracture. The aim of this study was to assess bone geometry, volumetric bone mineral density (vBMD), trabecular microarchitecture and estimated failure load in weight-bearing vs. non-weight-bearing bones...

  7. Reduced Automatic Motivational Orientation Towards Food in Restricting Anorexia Nervosa

    NARCIS (Netherlands)

    Veenstra, Esther M.; de Jong, Peter J.

    A striking and characteristic feature of the restricting subtype of anorexia nervosa (AN) is that they are extremely successful in regulating their food intake in a destructive manner. A possible explanation for the persistent character of their restricted food intake could be a loss of the

  8. An Outcome Study of Anorexia Nervosa in an Adolescent Unit.

    Science.gov (United States)

    Jenkins, M. E.

    1987-01-01

    Adolescent girls (N=21) treated for anorexia nervosa in a hospital operating a strict refeeding program were examined 3 years after treatment. Outcome was considered good for 10 girls, intermediate for 4 girls, and poor for 5 girls. Found lack of separation from parents at follow-up. Discusses relevance of findings to treatment approach and to…

  9. A Primary Prevention Program to Reduce Bulimia and Anorexia Nervosa.

    Science.gov (United States)

    Cullari, Salvatore; Redmon, William K.

    This paper presents a theoretical model for a primary prevention program for bulimia and anorexia nervosa to be used with adolescents and young women considered most at risk of developing these eating disorders. Characteristics of potential anorexics and bulimics are identified to aid in the selection of target groups for the program. It is…

  10. Nurse evaluation of hyperactivity in anorexia nervosa : A comparative study

    NARCIS (Netherlands)

    van Elburg, Annemarie A.; Hoek, Hans W.; Kas, Martien J.H.; van Engeland, Herman

    2007-01-01

    Up to 80% of patients with anorexia nervosa (AN) manifest elevated levels of physical activity or hyperactivity. A variety of methods have been used to evaluate activity levels, mostly questionnaires but also expensive and invasive methods such as actometry or other measurements of energy

  11. Anorexia nervosa with massive pulmonary air leak and extraordinary propagation

    DEFF Research Database (Denmark)

    Jensen, V. M.; Støving, R. K.; Andersen, Poul Erik

    2017-01-01

    A rare case combining pneumothorax, pneumomediastinum, pneumopericardium, pneumoperitoneum, pneumorrhachis, air in retroperitoneum and extensive subcutaneous emphysema simultaneously in a severely anorectic male with BMI 9.2 (22.8 kg) and multiple vomitings is presented. This unusual condition wa...... was treated successfully with conservative medical approach in a specialized somatic unit for anorexia nervosa....

  12. Determinants of Adolescent Obesity: A Comparison with Anorexia Nervosa.

    Science.gov (United States)

    Brone, Ronald J.; Fisher, Celia B.

    1988-01-01

    Comparison of childhood and adolescent obesity and anorexia nervosa reveals etiological similarities between the two conditions, particularly regarding family interactional patterns. In both cases, family enmeshment and overprotectiveness resulted in a poor sense of identity and effectiveness. Some children, while compliant and dependent in…

  13. Anorexia Nervosa in Adolescence and Maudsley Family-Based Treatment

    Science.gov (United States)

    Hurst, Kim; Read, Shelly; Wallis, Andrew

    2012-01-01

    Anorexia nervosa is a serious psychiatric disorder that usually occurs in adolescence. The course of the illness can be protracted. Current empirical evidence suggests that the Maudsley Family-Based Treatment (MFBT) is efficacious for adolescents. MFBT empowers parents as a crucial treatment resource to assist in their child's recovery. The…

  14. Anorexia nervosa ses ofte sammen medandre psykiatriske lidelser

    DEFF Research Database (Denmark)

    Panchenko, Anna; Arnfred, Sidse Marie Hemmingsen

    2015-01-01

    Recent literature is explored focusing on the relationship between symptoms of anorexia nervosa (AN) and other psychiatric disorders and lines of treatment. In AN, restrictive subtype, anxiety and obsessive-compulsive disorders are the most frequent co-morbidities. In AN, bulimic subtype...

  15. Using the Activity-based Anorexia Rodent Model to Study the Neurobiological Basis of Anorexia Nervosa.

    Science.gov (United States)

    Chowdhury, Tara Gunkali; Chen, Yi-Wen; Aoki, Chiye

    2015-10-22

    Anorexia nervosa (AN) is a psychiatric illness characterized by excessively restricted caloric intake and abnormally high levels of physical activity. A challenging illness to treat, due to the lack of understanding of the underlying neurobiology, AN has the highest mortality rate among psychiatric illnesses. To address this need, neuroscientists are using an animal model to study how neural circuits may contribute toward vulnerability to AN and may be affected by AN. Activity-based anorexia (ABA) is a bio-behavioral phenomenon described in rodents that models the key symptoms of anorexia nervosa. When rodents with free access to voluntary exercise on a running wheel experience food restriction, they become hyperactive - running more than animals with free access to food. Here, we describe the procedures by which ABA is induced in adolescent female C57BL/6 mice. On postnatal day 36 (P36), the animal is housed with access to voluntary exercise on a running wheel. After 4 days of acclimation to the running wheel, on P40, all food is removed from the cage. For the next 3 days, food is returned to the cage (allowing animals free food access) for 2 hr daily. After the fourth day of food restriction, free access to food is returned and the running wheel is removed from the cage to allow the animals to recover. Continuous multi-day analysis of running wheel activity shows that mice become hyperactive within 24 hr following the onset of food restriction. The mice run even during the limited time during which they have access to food. Additionally, the circadian pattern of wheel running becomes disrupted by the experience of food restriction. We have been able to correlate neurobiological changes with various aspects of the animals' wheel running behavior to implicate particular brain regions and neurochemical changes with resilience and vulnerability to food-restriction induced hyperactivity.

  16. Complicações clínicas da anorexia nervosa e bulimia nervosa Medical complications of anorexia nervosa and bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Carmen Leal de Assumpção

    2002-12-01

    Full Text Available Os transtornos alimentares estão associados a diversas complicações clínicas graves. Distúrbios hidroeletrolíticos e metabólicos assim como várias alterações endócrinas podem estar presentes, muitas dessas decorrentes da perda de peso e dos métodos compensatórios utilizados pelos pacientes. São importantes a identificação precoce e o manuseio adequado dessas complicações para a redução dos riscos relacionados. O objetivo desse artigo é discutir as complicações clínicas associadas com a anorexia nervosa e a bulimia nervosa.Eating disorders are associated with potentially serious medical complications. Metabolic and electrolyte abnormalities and endocrine alterations can be present and many of them result from the weight loss and the purging behaviors seen in these patients. Early diagnosis and an adequate management of these complications are important to reduce the risks associated. The aim of this article is to discuss the medical complications of anorexia nervosa and bulimia nervosa.

  17. [Mental disorders among relatives of patients with anorexia nervosa and bulimia nervosa].

    Science.gov (United States)

    Wagner, Angela; Wöckel, Lars; Bölte, Sven; Radeloff, Daniel; Lehmkuhl, Gerd; Schmidt, Martin H; Poustka, Fritz

    2008-05-01

    Family studies of anorexia (AN) and bulimia (BN) nervosa in relatives of patients with eating disorders compared to control subjects are rare in German-speaking countries. A German multicenter study compared first-, second- and third-degree relatives of 65 adolescent AN subjects (n = 746), 21 adolescent BN subjects (n = 265) and relatives of 11 adolescent depressive control subjects (n = 157), as well as those of 37 adolescent healthy control subjects (n = 480). Assessments included the Diagnostic Interview for Genetic Studies (DIGS), the short form of the Family Interview of Genetic Studies (FIGS), and the Eating Disorder Family History Interview. Rates of anorexia nervosa and major depressive disorder (trend) were significantly (p anorexia and bulimia nervosa. The observed differences in comorbidity patterns among eating-disordered relatives may be due to an age effect of the index patients.

  18. Fat Attenuation at CT in Anorexia Nervosa

    Science.gov (United States)

    Gill, Corey M.; Torriani, Martin; Murphy, Rachel; Harris, Tamara B.; Miller, Karen K.; Klibanski, Anne

    2016-01-01

    Purpose To investigate the composition, cross-sectional area (CSA), and hormonal correlates of different fat depots in women with anorexia nervosa (AN) and control subjects with normal weights to find out whether patients with AN have lower fat CSA but higher attenuation than did control subjects and whether these changes may be mediated by gonadal steroids, cortisol, and thyroid hormones. Materials and Methods This study was institutional review board approved and HIPAA compliant. Written informed consent was obtained. Forty premenopausal women with AN and 40 normal-weight women of comparable age (mean age ± standard deviation, 26 years ± 5) were studied. All individuals underwent computed tomography of the abdomen and thigh with a calibration phantom. Abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), thigh SAT, and thigh intermuscular adipose tissue CSA and attenuation were quantified. Serum estradiol, thyroid hormones, and urinary free cortisol levels were assessed. Variables were compared by using analysis of variance. Associations were examined by using linear regression analysis. Results Women with AN had higher fat attenuation than did control subjects (−100.1 to −46.7 HU vs −117.6 to −61.8 HU, P < .0001), despite lower fat CSA (2.0–62.8 cm2 vs 5.5–185.9 cm2, P < .0001). VAT attenuation but not CSA was inversely associated with lowest prior lifetime body mass index in AN (r = −0.71, P = .006). Serum estradiol levels were inversely associated with fat attenuation (r = −0.34 to −0.61, P = .03 to <.0001) and were positively associated with fat CSA of all compartments (r = 0.42–0.64, P = .007 to <.0001). Thyroxine levels and urinary free cortisol levels were positively associated with thigh SAT attenuation (r = 0.64 [P = .006] and r = 0.68 [P = .0004], respectively) and were inversely associated with abdominal SAT and VAT CSA (r = −0.44 to −0.58, P = .04 to .02). Conclusion Women with AN have differences in fat

  19. Effectiveness of individualized, integrative outpatient treatment for females with anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Freudenberg, Cara; Jones, Rebecca A; Livingston, Genvieve; Goetsch, Virginia; Schaffner, Angela; Buchanan, Linda

    2016-01-01

    The effectiveness of an individualized outpatient program was investigated in the treatment of bulimia nervosa (BN) and anorexia nervosa (AN). Participants included 151 females who received outpatient eating disorder treatment in the partial hospitalization program, the intensive outpatient program, or a combination of the two programs. Outcome measures included the Eating Disorder Inventory (EDI-2), Beck Depression Inventory (BDI-II), frequency of binge eating and purging, and mean body weight. Findings included significant increases in weight for the AN group, reductions in binge eating frequency for the BN group, and reductions in EDI-2 and BDI-II scores and purging frequency for both groups. This study provides preliminary support for the efficacy of a multimodal program for the treatment of both anorexia nervosa and bulimia nervosa.

  20. Has food lost its attraction in anorexia nervosa? : A cognitive approach

    NARCIS (Netherlands)

    Neimeijer, Renate Antonia Maria

    2018-01-01

    De aantrekkingskracht van voedsel in Anorexia Nervosa Veel mensen doen aan de lijn, maar een dieet vol houden is voor de meesten van ons niet gemakkelijk. Dit ligt heel anders voor mensen met anorexia nervosa. In dit onderzoek wilden we beter begrijpen hoe het kan dat mensen met anorexia zo “goed

  1. Readiness to Recover in Adolescent Anorexia Nervosa: Prediction of Hospital Admission

    Science.gov (United States)

    Ametller, L.; Castro, J.; Serrano, E.; Martinez, E.; Toro, J.

    2005-01-01

    Objectives: To determine if motivation to change in anorexia nervosa during treatment is a predictor of hospitalisation in adolescent patients. Method: The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ), the Eating Disorders Inventory-2 (EDI-2) and the Beck Depression Inventory (BDI) were administered to a group of 70 anorexia nervosa…

  2. Anorexia nervosa and bulimia nervosa - a psychotherapeutic cognitive-constructivist approach.

    Science.gov (United States)

    Abreu, Cristiano Nabuco de; Cangelli Filho, Raphael

    2017-06-01

    Of the eating disorders, anorexia nervosa and bulimia nervosa are the ones that have made adolescent patients-often females and aged younger and younger-seek for help. This help is provided through a multidisciplinary treatment involving psychiatrists, psychologists and dietists. Psychotherapy has shown to be an efficient component for these patients' improvement. The present article aims at presenting a proposal of psychotherapeutic treatment based on a cognitive-constructivist approach.

  3. Somatic comorbidity in anorexia nervosa: First results of a 21-year follow-up study on female inpatients

    Science.gov (United States)

    2012-01-01

    inpatients with somatic comorbidity (n = 6, 66.7%) than among inpatients without a somatic disease (n = 3, 33.3%; p = .03). Somatic comorbidity was a significant coefficient in a multivariate survival model (B = 2.32, p = .04). Conclusion Somatic comorbidity seems to be an important factor for anorexia nervosa outcome and should be included in multivariate analyses on the long-term course of anorexia nervosa as an independent variable. Further investigations are needed in order to understand in which way anorexia nervosa and a somatic disease can interact. PMID:22300749

  4. Increased P-wave dispersion a risk for atrial fibrillation in adolescents with anorexia nervosa.

    Science.gov (United States)

    Ertuğrul, İlker; Akgül, Sinem; Derman, Orhan; Karagöz, Tevfik; Kanbur, Nuray

    2016-01-01

    Studies have shown that a prolonged P-wave dispersion is a risk factor for the development of atrial fibrillation. The aim of this study was to evaluate P-wave dispersion in adolescents with anorexia nervosa at diagnosis. We evaluated electrocardiographic findings, particularly the P-wave dispersion, at initial assessment in 47 adolescents with anorexia nervosa. Comparison of P-wave dispersion between adolescents with anorexia nervosa and controls showed a statistically significant higher P-wave dispersion in patients with anorexia nervosa (72 ± 16.3 msec) when compared to the control group (43.8 ± 9.5 msec). Percent of body weight lost, lower body mass index, and higher weight loss rate in the patients with anorexia nervosa had no effect on P-wave dispersion. Due to the fact that anorexia nervosa has a high mortality rate we believe that cardiac pathologies such as atrial fibrillation must also be considered in the medical evaluation.

  5. Anorexia nervosa versus hyperinsulinism: therapeutic effects of neuropharmacological manipulation

    Directory of Open Access Journals (Sweden)

    Fuad Lechin

    2011-02-01

    Full Text Available Fuad Lechin1,2, Bertha van der Dijs1,2, Betty Pardey-Maldonado1, Scarlet Baez1, Marcel E Lechin31Sections of Neuroendocrinology, Neuropharmacology, and Neurochemistry, Department of Pathophysiology, Institute of Experimental Medicine, Faculty of Medicine, Universidad Central de Venezuela, Caracas; 2Instituto de Vias Digestivas Caracas, Centro Clínico Profesional Caracas, Venezuela; 3Department of Internal Medicine, Texas A & M Health Science Center, College of Medicine, Texas, USABackground: We have demonstrated that anorexia nervosa is underpinned by overwhelming adrenal sympathetic activity which abolishes the neural sympathetic branch of the peripheral autonomic nervous system. This physiological disorder is responsible for gastrointestinal hypomotility, hyperglycemia, raised systolic blood pressure, raised heart rate, and other neuroendocrine disorders. Therefore, we prescribed neuropharmacological therapy to reverse this central and autonomic nervous system disorder, in order to normalize the clinical and neuroendocrine profile.Methods: The study included 22 female patients with anorexia nervosa (10 restricted type, 12 binge-eating type who received three months of treatment with amantadine 100 mg/day. We measured blood pressure, heart rate, and circulating neurotransmitters, (noradrenaline, adrenaline, dopamine, platelet serotonin, free plasma serotonin during supine resting, one minute of orthostasis, and a five-minute exercise test before and after one, two, and three months of treatment with amantadine, a drug which abrogates adrenal sympathetic activity by acting at the C1(Ad medullary nuclei responsible for this branch of the peripheral sympathetic activity.Results: We found the amantadine abolished symptoms of anorexia nervosa from the first oral dose onwards. Normalization of autonomic and cardiovascular parameters was demonstrated within the early days of therapy. Abrupt and sustained increases in the plasma noradrenaline

  6. Anorexia Nervosa: A Unified Neurological Perspective

    Science.gov (United States)

    Hasan, Tasneem Fatema; Hasan, Hunaid

    2011-01-01

    The roles of corticotrophin-releasing factor (CRF), opioid peptides, leptin and ghrelin in anorexia nervosa (AN) were discussed in this paper. CRF is the key mediator of the hypothalamo-pituitary-adrenal (HPA) axis and also acts at various other parts of the brain, such as the limbic system and the peripheral nervous system. CRF action is mediated through the CRF1 and CRF2 receptors, with both HPA axis-dependent and HPA axis-independent actions, where the latter shows nil involvement of the autonomic nervous system. CRF1 receptors mediate both the HPA axis-dependent and independent pathways through CRF, while the CRF2 receptors exclusively mediate the HPA axis-independent pathways through urocortin. Opioid peptides are involved in the adaptation and regulation of energy intake and utilization through reward-related behavior. Opioids play a role in the addictive component of AN, as described by the “auto-addiction opioids theory”. Their interactions have demonstrated the psychological aspect of AN and have shown to prevent the functioning of the physiological homeostasis. Important opioids involved are β-lipotropin, β-endorphin and dynorphin, which interact with both µ and κ opioids receptors to regulate reward-mediated behavior and describe the higher incidence of AN seen in females. Moreover, ghrelin is known as the “hunger” hormone and helps stimulate growth hormone (GH) and hepatic insulin-like-growth-factor-1(IGF-1), maintaining anabolism and preserving a lean body mass. In AN, high levels of GH due to GH resistance along with low levels of IGF-1 are observed. Leptin plays a role in suppressing appetite through the inhibition of neuropeptide Y gene. Moreover, the CRF, opioid, leptin and ghrelin mechanisms operate collectively at the HPA axis and express the physiological and psychological components of AN. Fear conditioning is an intricate learning process occurring at the level of the hippocampus, amygdala, lateral septum and the dorsal raphe by

  7. A Brief Review of the Biology of Anorexia Nervosa

    DEFF Research Database (Denmark)

    Sjögren, Magnus

    2015-01-01

    Background: The etiology of Anorexia Nervosa (AN) is unknown. A stress model for AN and other Eating Disorders, has been proposed by Connan and depicts risk factors and precipitating events, including biological, but several steps in this have yet to be evidenced. In order to elucidate the biology...... PUBMED and the following search terms: “Anorexia Nervosa” and “biomarker” revealed 180 articles (8th of May 2015). Additional searches included the search terms “gene”, “genetic”, “epigenetic”, “appetite”, “hormone”, and a specific search on “biology” and “review”. Furthermore, articles of interest were...

  8. Position of the American Dietetic Association: Nutrition intervention in the treatment of anorexia nervosa, bulimia nervosa, and other eating disorders.

    Science.gov (United States)

    2006-12-01

    It is the position of the American Dietetic Association that nutrition intervention, including nutritional counseling, by a registered dietitian (RD) is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and other eating disorders during assessment and treatment across the continuum of care. Diagnostic criteria for eating disorders provide important guidelines for identification and treatment. However, it is thought that a continuum of disordered eating may exist that ranges from persistent dieting to subthreshold conditions and then to defined eating disorders, which include anorexia nervosa, bulimia nervosa, and binge eating disorder. Understanding the complexities of eating disorders, such as influencing factors, comorbid illness, medical and psychological complications, and boundary issues, is critical in the effective treatment of eating disorders. The nature of eating disorders requires a collaborative approach by an interdisciplinary team of psychological, nutritional, and medical specialists. The RD is an integral member of the treatment team and is uniquely qualified to provide medical nutrition therapy for the normalization of eating patterns and nutritional status. RDs provide nutritional counseling, recognize clinical signs related to eating disorders, and assist with medical monitoring while cognizant of psychotherapy and pharmacotherapy that are cornerstones of eating disorder treatment. Specialized resources are available for RDs to advance their level of expertise in the field of eating disorders. Further efforts with evidenced-based research must continue for improved treatment outcomes related to eating disorders along with identification of effective primary and secondary interventions.

  9. Medical complications of anorexia nervosa and their treatments: an update on some critical aspects.

    Science.gov (United States)

    Brown, Carrie; Mehler, Philip S

    2015-12-01

    Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Many of the deaths are attributable to medical complications which arise as the malnutrition and weight loss worsens. Every body system may be adversely affected by anorexia nervosa. Yet, remarkably, most of the medical complications of anorexia nervosa are treatable and reversible with optimal medical care, as part of a multidisciplinary team who are often involved in the care of these patients. Herein, we will describe the medical complications of anorexia nervosa and their treatments.

  10. Grey matter correlates of autistic traits in women with anorexia nervosa.

    Science.gov (United States)

    Björnsdotter, Malin; Davidovic, Monika; Karjalainen, Louise; Starck, Göran; Olausson, Håkan; Wentz, Elisabet

    2018-03-01

    Patients with anorexia nervosa exhibit higher levels of behaviours typically associated with autism-spectrum disorder (ASD), but the neural basis is unclear. We sought to determine whether elevated autistic traits in women with anorexia nervosa may be reflected in cortical morphology. We used voxel-based morphometry (VBM) to examine regional grey matter volumes in high-resolution MRI structural brain scans in women with anorexia nervosa and matched healthy controls. The Autism-spectrum Quotient (AQ) scale was used to assess autistic traits. Women with anorexia nervosa ( n = 25) had higher AQ scores and lower bilateral superior temporal sulcus (STS) grey matter volumes than the control group ( n = 25). The AQ scores correlated negatively with average left STS grey matter volume in women with anorexia nervosa. We did not control for cognitive ability and examined only women with ongoing anorexia nervosa. Elevated autistic traits in women with anorexia nervosa are associated with morphometric alterations of brain areas linked to social cognition. This finding provides neurobiological support for the behavioural link between anorexia nervosa and ASD and emphasizes the importance of recognizing autistic traits in preventing and treating anorexia nervosa.

  11. Diagnosed Anxiety Disorders and the Risk of Subsequent Anorexia Nervosa: A Danish Population Register Study.

    Science.gov (United States)

    Meier, Sandra M; Bulik, Cynthia M; Thornton, Laura M; Mattheisen, Manuel; Mortensen, Preben B; Petersen, Liselotte

    2015-11-01

    Anxiety disorders and anorexia nervosa are frequently acknowledged to be highly comorbid conditions, but still, little is known about the clinical and aetiological cohesion of specific anxiety diagnoses and anorexia nervosa. Using the comprehensive Danish population registers, we aimed to determine the risk of anorexia nervosa in patients with register-detected severe anxiety disorders. We also explored whether parental psychopathology was associated with offspring's anorexia nervosa. Anxiety disorders increased the risk of subsequent anorexia nervosa, with the highest risk observed in obsessive-compulsive disorder. Especially, male anxiety patients were at an increased risk for anorexia nervosa. Furthermore, an increased risk was observed in offspring of fathers with panic disorder. A diagnosis of an anxiety disorder, specifically obsessive-compulsive disorder, constitutes a risk factor for subsequent diagnosis of anorexia nervosa. These observations support the notion that anxiety disorders and anorexia nervosa share etiological mechanisms and/or that anxiety represents one developmental pathway to anorexia nervosa. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  12. Grey matter correlates of autistic traits in women with anorexia nervosa

    Science.gov (United States)

    Davidovic, Monika; Karjalainen, Louise; Starck, Göran; Olausson, Håkan; Wentz, Elisabet

    2018-01-01

    Background Patients with anorexia nervosa exhibit higher levels of behaviours typically associated with autism-spectrum disorder (ASD), but the neural basis is unclear. We sought to determine whether elevated autistic traits in women with anorexia nervosa may be reflected in cortical morphology. Methods We used voxel-based morphometry (VBM) to examine regional grey matter volumes in high-resolution MRI structural brain scans in women with anorexia nervosa and matched healthy controls. The Autism-spectrum Quotient (AQ) scale was used to assess autistic traits. Results Women with anorexia nervosa (n = 25) had higher AQ scores and lower bilateral superior temporal sulcus (STS) grey matter volumes than the control group (n = 25). The AQ scores correlated negatively with average left STS grey matter volume in women with anorexia nervosa. Limitations We did not control for cognitive ability and examined only women with ongoing anorexia nervosa. Conclusion Elevated autistic traits in women with anorexia nervosa are associated with morphometric alterations of brain areas linked to social cognition. This finding provides neurobiological support for the behavioural link between anorexia nervosa and ASD and emphasizes the importance of recognizing autistic traits in preventing and treating anorexia nervosa. PMID:29481315

  13. New recommendations for management of eating disorders (anorexia nervosa, bulimia nervosa from NICE

    Directory of Open Access Journals (Sweden)

    Vitaliy Bezsheiko

    2017-08-01

    Full Text Available The UK's National Institute for Health and Care Excellence (NICE, one of the most authoritative institutions in the field of evidence-based medicine, has issued standards for management of patients with anorexia and bulimia nervosa.

  14. Peculiar enlargement of the nasopharynx in patients with anorexia nervosa

    International Nuclear Information System (INIS)

    Okamoto, K.; Ito, J.; Tokiguchi, S.; Kuwabara, G.; Nishihara, M.

    1995-01-01

    We examined the nasopharynx and brain in 17 patients with anorexia nervosa by CT and compared the findings with those of 44 normal subjects and of 5 patients of the same age with marked emaciation caused by various psychiatric disorders. An enlarged nasopharyngeal space with a flattened posterior wall and enlarged lateral pharyngeal recesses were demonstrated in all patients with anorexia nervosa whose weight was lowest at the time of the CT examination, and these CT features regressed or became normal quickly after they had gained some weight. This characteristic enlargement of the nasopharynx and lateral pharyngeal recesses was observed neither in the markedly emaciated patients (2 with schizophrenia, 1 with major depression, 1 with stupor and the other with an extremely unbalanced diet) nor in 44 normal subjects without emaciation. These features were therefore thought to be characteristic and of diagnostic significance. (orig.). With 5 figs., 3 tabs

  15. Peculiar enlargement of the nasopharynx in patients with anorexia nervosa

    Energy Technology Data Exchange (ETDEWEB)

    Okamoto, K. [Department of Radiology, School of Dentistry, Niigata Univ. (Japan); Ito, J. [Department of Radiology, School of Dentistry, Niigata Univ. (Japan); Tokiguchi, S. [Department of Radiology, School of Dentistry, Niigata Univ. (Japan); Kuwabara, G. [Department of Radiology, School of Medicine, Niigata University, Niigata (Japan); Nishihara, M. [Department of Radiology, School of Medicine, Niigata University, Niigata (Japan)

    1995-11-01

    We examined the nasopharynx and brain in 17 patients with anorexia nervosa by CT and compared the findings with those of 44 normal subjects and of 5 patients of the same age with marked emaciation caused by various psychiatric disorders. An enlarged nasopharyngeal space with a flattened posterior wall and enlarged lateral pharyngeal recesses were demonstrated in all patients with anorexia nervosa whose weight was lowest at the time of the CT examination, and these CT features regressed or became normal quickly after they had gained some weight. This characteristic enlargement of the nasopharynx and lateral pharyngeal recesses was observed neither in the markedly emaciated patients (2 with schizophrenia, 1 with major depression, 1 with stupor and the other with an extremely unbalanced diet) nor in 44 normal subjects without emaciation. These features were therefore thought to be characteristic and of diagnostic significance. (orig.). With 5 figs., 3 tabs.

  16. MRI demonstration of orbital lipolysis in anorexia nervosa

    International Nuclear Information System (INIS)

    Demaerel, Philippe; Dekimpe, Piet; Wilms, Guy; Muls, Erik

    2002-01-01

    The purpose of this article is to describe the orbital changes due to lipolysis in anorexia nervosa. We examined a cachectic patient with MR imaging using T1-weighted images before and after contrast enhancement. Orbital fat edema has been observed in extreme forms of cachexia and the CT and MR findings have recently been reported. The imaging appearances have been explained by the disappearance of the fat tissue and the appearance of edema due to a disturbance in the electrolyte fluid balance. In the recent literature particular attention has been paid to the increased lipid peroxidation and lipolysis in anorexia nervosa. These metabolic processes result in an increased permeability of the vessel wall endothelium, which can explain the extravasation of the contrast agent in the orbital fat on MR imaging. (orig.)

  17. MRI demonstration of orbital lipolysis in anorexia nervosa

    Energy Technology Data Exchange (ETDEWEB)

    Demaerel, Philippe; Dekimpe, Piet; Wilms, Guy [Department of Radiology, University Hospitals, Herestraat 49, 3000 Leuven (Belgium); Muls, Erik [Department of Endocrinology, University Hospitals, Herestraat 49, 3000 Leuven (Belgium)

    2002-07-01

    The purpose of this article is to describe the orbital changes due to lipolysis in anorexia nervosa. We examined a cachectic patient with MR imaging using T1-weighted images before and after contrast enhancement. Orbital fat edema has been observed in extreme forms of cachexia and the CT and MR findings have recently been reported. The imaging appearances have been explained by the disappearance of the fat tissue and the appearance of edema due to a disturbance in the electrolyte fluid balance. In the recent literature particular attention has been paid to the increased lipid peroxidation and lipolysis in anorexia nervosa. These metabolic processes result in an increased permeability of the vessel wall endothelium, which can explain the extravasation of the contrast agent in the orbital fat on MR imaging. (orig.)

  18. Raynaud's phenomenon and nailfold capillaroscopic findings in anorexia nervosa.

    Science.gov (United States)

    De Martinis, Massimo; Sirufo, Maria Maddalena; Ginaldi, Lia

    2018-03-01

    Peripheral vascular abnormalities caused by a dysregulation between peripheral vasoconstriction and vasodilatation, clinically appearing with Raynaud's phenomenon, have been described in anorexia nervosa but specific characteristics of microcirculation in anorexic patients have not yet been studied. We performed nailfold videocapillaroscopy to assess microcirculatory alteration in anorexic patients and found three different patterns: normal, aspecific and early scleroderma pattern. We also evaluated several laboratory and clinical parameters to better assess our capillaroscopic findings. None of the clinical parameters examined correlated with specific capillaroscopic findings. An increased risk of autoimmune diseases in eating disorder patients has been described. Our results evidenced an association between early scleroderma capillaroscopic pattern and Raynaud's phenomenon that occurs in anorexia nervosa patients, whereas no significant association was found between all three capillaroscopic patterns and the presence of autoantibodies, as well as ESR and CRP values. Our study reveals that patients with AN suffering from RP exhibit NVC findings typical of connective tissue diseases.

  19. Celiac disease and anorexia nervosa: a case report

    Directory of Open Access Journals (Sweden)

    Emilie L. Deschner

    2017-12-01

    Full Text Available The relationship between anorexia nervosa and celiac disease remains an area of ongoing research. Identification of celiac disease in patients with restricted nutritional intake can be challenging since abdominal complaints are a common comorbidity associated with eating disorders and since diagnosis of celiac disease requires a duodenal biopsy while on a gluten containing diet. In this report, we present a 12-year-old female who developed anorexia nervosa and was thereafter diagnosed with celiac disease. The latter diagnosis occurred after a 2-year period of persistent abdominal complaints and duodenal biopsies on three separate occasions. Our case highlights the diagnostic challenge, which may include initially missing the diagnosis, associated with celiac disease in patients who are restricting their nutritional intake, and also the importance of re-testing in patients where gastrointestinal complaints are persistent for extended time periods after refeeding.

  20. Impaired central processing of emotional faces in anorexia nervosa.

    Science.gov (United States)

    Pollatos, Olga; Herbert, Beate M; Schandry, Rainer; Gramann, Klaus

    2008-07-01

    To elucidate the potential relationship between classification of emotional faces and impaired central processing in eating disorders and to investigate the potential mediatory role of alexithymia and depression in this relationship. Visual-evoked potentials (VEPs) to emotional faces and classification performance were assessed in 12 anorexic females and matched healthy controls. Patients with anorexia nervosa showed no modulation of emotional face processing and displayed significantly increased N200 amplitudes in response to all emotional categories and decreased VEPs in response to unpleasant emotional faces in the P300 time range as compared with healthy controls. They also made more mistakes in emotional face recognition, in particular, for neutral, sad, and disgusted content. There are marked differences in evoked potentials and emotion recognition performances of patients with anorexia nervosa and controls in facial processing. Differences in brain dynamics might contribute to difficulties in the correct recognition of facially expressed emotions, deficits in social functioning, and in turn the maintenance of eating disorders.

  1. Anorexia nervosa and bulimia nervosa. When the pursuit of bodily 'perfection' becomes a killer.

    Science.gov (United States)

    Zerbe, K J

    1996-01-01

    Eating disorders probably result from a combination of emotional, physical, and sociologic factors and are encouraged by a society that values appearance as a measure of worth. Once believed to be a problem largely among young women, the disorders are being found increasingly among children, young athletes, men, and elderly women. Often accompanied by depression, anxiety, and personality disorders, eating disorders may be difficult to diagnose. Patients with anorexia nervosa often deny that they have a problem, despite obvious physical signs. Patients with bulimia nervosa may hide their binging and purging and have no overt signs. Primary care physicians may be the first to suspect potential problems, including a patient's fixation on food, weight, dieting, physique, and exercise. Sometimes, patients who have struggled in silence for years turn to their trusted physician for support and understanding. The first step in treatment is to address the medical complications caused by the unhealthy eating habits. Once nutritional health has been restored, patients need to reverse their entrenched and distorted body-image ideas through psychotherapy.

  2. Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder in Midlife and Beyond.

    Science.gov (United States)

    Elran-Barak, Roni; Fitzsimmons-Craft, Ellen E; Benyamini, Yael; Crow, Scott J; Peterson, Carol B; Hill, Laura L; Crosby, Ross D; Mitchell, James E; Le Grange, Daniel

    2015-08-01

    We examined eating disorders in midlife and beyond by comparing frequency of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding or eating disorder (OSFED) among midlife eating disorder treatment-seeking individuals and younger controls. We also compared demographic and eating disorder-related characteristics across diagnoses and age groups. Participants included 2,118 treatment-seeking adults who self-reported their eating-related symptoms on the Eating Disorder Questionnaire. Results showed that percent of patients with BN was significantly lower whereas percent of patients with BED and OSFED was significantly higher among midlife relative to younger patients. Percent of patients with AN did not differ between midlife and younger patients. Additionally, midlife and younger patients with BED and OSFED differed on several demographic (e.g., marital status) and eating disorder-related characteristics (e.g., BMI, compulsive exercising). This study suggests that BN is less common whereas BED and OSFED are more common among midlife eating disorder treatment-seeking individuals relative to younger controls. In addition, AN and BN present fairly similarly whereas BED and OSFED present fairly differently among midlife patients relative to younger controls. Attention to these differences and similarities is necessary to understand eating disorders in midlife.

  3. Early-onset anorexia nervosa in girls with Asperger syndrome.

    Science.gov (United States)

    Dudova, Iva; Kocourkova, Jana; Koutek, Jiri

    2015-01-01

    Eating disorders frequently occur in conjunction with autism spectrum disorders, posing diagnostic and therapeutic difficulties. The comorbidity of anorexia nervosa and Asperger syndrome is a significant clinical complication and has been associated with a poorer prognosis. The authors are presenting the cases of an eleven-year-old girl and a five-and-a-half-year-old girl with comorbid eating disorders and Asperger syndrome.

  4. Amenorrhea as a Diagnostic Criterion for Anorexia Nervosa

    OpenAIRE

    Vellisca González, María Yolanda; Hospital Obispo Polanco; Latorre Marín, José Ignacio; Santed Germán, Miguel Ángel; Orejudo Hernández, Santos

    2012-01-01

    Amenorrhea is a current criterion for the diagnosis of anorexia nervosa (AN) according to the DSM-IV-TR. Nevertheless, when comparing groups of patients who fulfill all the criteria of this manual for AN and groups of women who show them all but amenorrhea, some studies did not find significant differences in the psychopathology typically associated with AN. The purpose of our study was to compare both groups in demographic, anthropometric, psychological and psychopathological variables. Ther...

  5. Refeeding Hypophosphatemia in Adolescents With Anorexia Nervosa: A Systematic Review

    OpenAIRE

    O Connor, G.; Nicholls, D.

    2013-01-01

    The rate of adolescents presenting with anorexia nervosa (AN) is increasing. Medically unstable adolescents are admitted to the hospital for nutrition restoration. A lack of global consensus on appropriate refeeding practices of malnourished patients has resulted in inconsistent refeeding practices. Refeeding hypophosphatemia (RH) is the most common complication associated with refeeding the malnourished patient. This review sought to identify the range of refeeding rates adopted globally and...

  6. [Nutrition and behavioral eating disorders: anorexia and bulimia nervosa].

    Science.gov (United States)

    Miján de la Torre, A; Velasco Vallejo, J L

    1999-05-01

    Behavioral eating disorders (BED's) have shown an intense growth in the last years. They are considered to be caused by multiple factors, showing a bio-psycho-socio-cultural etiology. Although there are clinical signs that could alert the physician and allow an early diagnosis, their final diagnosis must meet certain criteria set in the DSM-IV (1994). Despite the fact that anorexia nervosa and bulimia nervosa in their typical forms, are the most known, there are atypical or incomplete forms of both that should be kept in mind when making the diagnosis. Anorexia nervosa is accompanied by somatic-nutritional problems that may condition the patient's life, requiring specific nutritional care. Bulimia nervosa is often accompanied by medical complications that require an exhaustive assessment. As for the nutritional support in anorexia nervosa, this must be proportional to the nutritional status of the patient and there should be no hesitation to resort to artificial nutrition using enteral nutrition through a tube in the case of severe malnutrition. In these cases there must be careful monitoring for the appearance of the re-nutrition syndrome, and this can be avoided by the slow and progressive administration of energetic nutrients, with special precautions in the supply of carbohydrates, and administering an adequate supplement of vitamins and electrolytes. Patients with a BED require a multi-disciplinary care with the simultaneous and coordinated action of a team of professionals. This type of care coupled with the experience of the team with regard to BED's and their treatment, and together with other actions and situations, may favor the final prognosis of a patient with a BED.

  7. Neuropsychological and Cognitive Correlates of Recovery in Anorexia Nervosa.

    Science.gov (United States)

    Harper, Jessica A; Brodrick, Brooks; Van Enkevort, Erin; McAdams, Carrie J

    2017-11-01

    To identify clinical or cognitive measures either predictive of illness trajectory or altered with sustained weight recovery in adult women with anorexia nervosa. Participants were recruited from prior studies of women with anorexia nervosa (AN-C) and in weight-recovery following anorexia nervosa (AN-WR). Participants completed a neuropsychological battery at baseline and clinical assessments at both baseline and follow-up. Groups based on clinical outcome (continued eating disorder, AN-CC; newly in recovery, AN-CR; sustained weight-recovery, AN-WR) were compared by using one-way ANOVAs with Bonferroni-corrected post hoc comparisons. Women with continued eating disorder had poorer neuropsychological function and self-competence at baseline than AN-CR. AN-CR showed changes in depression and externalizing bias, a measure of self-related attributions. AN-WR differed from both AN-CC and AN-CR at baseline in externalizing bias, but only from AN-CC at outcome. Neuropsychological function when recently ill may be a prognostic factor, while externalizing bias may provide a clinical target for recovery. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

  8. Risk factors in the development of anorexia nervosa

    Directory of Open Access Journals (Sweden)

    Lazarević Jovana

    2013-01-01

    Full Text Available Anorexia nervosa is a complex eating disorder characterized by the voluntary reduction, and subsequent maintenance, of body weight at a level below 85% of optimal body weight, a pathological fear of food and weight gain, and disturbance of experience of weight and body shape. Development, sustainability and complexity of symptoms depend upon different biological, psychological and social factors. The aim of the paper is to present risk factors that can significantly contribute to the development and severity of the symptoms of anorexia nervosa. This review paper presents the key factors in the development of the disorder. Attachment styles, perfectionism and concerns about body shape, as core psychological factors for development and severity of symptoms, are the principle areas discussed. Lack of self-esteem and self-confidence, unresolved emotional issues, high, unrealistic standards and ideals of physical appearance to which people rigidly hold and which they persistently and consistently attempt to reach, dissatisfaction with body shape, and significant discrepancy between perceived and ideal body image are all associated with maladaptive behavior and attitudes towards food, and often precede the diagnosis of the disorder. The review of research indicates that insecure emotional attachment styles, perfectionism and concern about body shape significantly correlate with symptoms of anorexia nervosa and represent risk and maintaining factors of the disorder. Focus on these problems can significantly contribute to more comprehensive prevention and treatment of the disorder.

  9. Anorexia Nervosa and Body Fat Distribution: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Marwan El Ghoch

    2014-09-01

    Full Text Available The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa. Literature searches, study selection, method development and quality appraisal were performed independently by two authors, and data was synthesized using a narrative approach. Twenty studies met the inclusion criteria and were consequently analyzed. The review had five main findings. First, during anorexia nervosa adolescent females lose more central body fat, while adult females more peripheral fat. Second, partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females. Third, after short-term weight restoration, whether partial or complete, adults show a central adiposity phenotype with respect to healthy age-matched controls. Fourth, central fat distribution is associated with increased insulin resistance, but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults. Fifth, the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration, indicating that preferential central distribution of body fat is a transitory phenomenon. However, a discrepancy in the findings has been noted, especially between adolescents and adults; besides age and gender, these appear to be related to differences in the methodology and time of body composition assessments. The PROSPERO Registry—Anorexia Nervosa and Body Fat Distribution: A Systematic Review (CRD42014008738.

  10. Anorexia Nervosa and Body Fat Distribution: A Systematic Review

    Science.gov (United States)

    El Ghoch, Marwan; Calugi, Simona; Lamburghini, Silvia; Dalle Grave, Riccardo

    2014-01-01

    The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa. Literature searches, study selection, method development and quality appraisal were performed independently by two authors, and data was synthesized using a narrative approach. Twenty studies met the inclusion criteria and were consequently analyzed. The review had five main findings. First, during anorexia nervosa adolescent females lose more central body fat, while adult females more peripheral fat. Second, partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females. Third, after short-term weight restoration, whether partial or complete, adults show a central adiposity phenotype with respect to healthy age-matched controls. Fourth, central fat distribution is associated with increased insulin resistance, but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults. Fifth, the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration, indicating that preferential central distribution of body fat is a transitory phenomenon. However, a discrepancy in the findings has been noted, especially between adolescents and adults; besides age and gender, these appear to be related to differences in the methodology and time of body composition assessments. The PROSPERO Registry—Anorexia Nervosa and Body Fat Distribution: A Systematic Review (CRD42014008738). PMID:25251296

  11. Refeeding hypophosphatemia in adolescents with anorexia nervosa: a systematic review.

    Science.gov (United States)

    O'Connor, Graeme; Nicholls, Dasha

    2013-06-01

    The rate of adolescents presenting with anorexia nervosa (AN) is increasing. Medically unstable adolescents are admitted to the hospital for nutrition restoration. A lack of global consensus on appropriate refeeding practices of malnourished patients has resulted in inconsistent refeeding practices. Refeeding hypophosphatemia (RH) is the most common complication associated with refeeding the malnourished patient. This review sought to identify the range of refeeding rates adopted globally and the implication that total energy intake and malnutrition may have on RH while refeeding adolescents with anorexia nervosa. Studies were identified by a systematic electronic search of medical databases from 1980 to September 2012. Seventeen publications were identified, including 6 chart reviews, 1 observational study, and 10 case reports, with a total of 1039 subjects. The average refeeding energy intake was 1186 kcal/d, ranging from 125-1900 kcal/d, with a mean percentage median body mass index (% mBMI) of 78%. The average incidence rate of RH was 14%. A significant correlation between malnutrition (% mBMI) and post-refeeding phosphate was identified (R (2) = 0.6, P = .01). This review highlights the disparity in refeeding rates adopted internationally in treating malnourished adolescents with anorexia nervosa. Based on this review, the severity of malnutrition seems to be a marker for the development of RH more so than total energy intake.

  12. Dual-energy CT (DECT) imaging of tophi and monosodium urate deposits in a patient with longstanding anorexia nervosa

    DEFF Research Database (Denmark)

    Weihe, Johan Petur; Birger Morillon, Melanie; Lambrechtsen, Jess

    Dual-energy CT (DECT) imaging of tophi and monosodium urate deposits in a patient with longstanding anorexia nervosa......Dual-energy CT (DECT) imaging of tophi and monosodium urate deposits in a patient with longstanding anorexia nervosa...

  13. A systematic review of the frequency, duration, type and effect of involuntary treatment for people with anorexia nervosa, and an analysis of patient characteristics

    DEFF Research Database (Denmark)

    Clausen, Loa; Jones, Allan

    2014-01-01

    OBJECTIVE: Involuntary treatment of anorexia nervosa is controversial and costly. A better understanding of the conditions that determine involuntary treatment, as well as the effect of such treatment is needed in order to adequately assess the legitimacy of this model of care. The aim...... the involuntary treatment of individuals diagnosed with anorexia nervosa. RESULTS: The studies included in the review contained people treated in an inpatient setting for severe or severe and enduring anorexia nervosa. People that were treated involuntarily were characterised by a more severe psychiatric load...

  14. A new service model for the treatment of severe anorexia nervosa in the community: the Anorexia Nervosa Intensive Treatment Team

    Science.gov (United States)

    Munro, Calum; Thomson, Victoria; Corr, Jean; Randell, Louise; Davies, Jennie E.; Gittoes, Claire; Honeyman, Vicky; Freeman, Chris P.

    2014-01-01

    Aims and method A community intensive treatment service for severe anorexia nervosa is described. The service is multidisciplinary but driven by a focus on psychological formulation. Psychological and dietetic interventions are grounded in a process of active risk management. Evaluations of safety, cost and acceptability of the service are described. Results Patients are highly satisfied with their care. A relatively low mortality rate for such a high-risk population was observed. In-patient bed use and costs were substantially reduced. Clinical implications There is a case for greater use of intensive community care for patients with severe anorexia nervosa, as it can be acceptable to patients, relatively safe and cost less than admission. PMID:25285220

  15. Accommodation of Symptoms in Anorexia Nervosa: A Qualitative Study.

    Science.gov (United States)

    Fox, John R E; Whittlesea, Anna

    2017-03-01

    Anorexia nervosa (AN) continues to remain poorly understood within eating disorders. Recent research and theory have moved away from understanding its aetiological causes, addressing instead potential maintaining factors. This study is focused on interpersonal maintenance factors: the response of close others. Relatives of those with AN typically carry the main burden of care, and research has found high levels of carer distress and unmet needs. Recent theories have proposed this emotional impact to contribute to expressed emotion and other unhelpful caregiver interactions which inadvertently maintain AN. One such understudied response is accommodation, described as a 'process' whereby caregivers 'assist or participate' in symptomatic behaviours of the cared for individual. There is a dearth of research relating to accommodation within eating disorders, particularly qualitative accounts. This study utilized a grounded theory methodology to explore caregivers' responses to managing AN, focusing particularly on carers' experience of accommodation. Eight participants with experience of caring for an individual diagnosed with AN were interviewed. Participants were recruited from a national eating disorder charity and regional eating disorder service. A number of themes emerged, including the importance of caregivers' emotional resources in mediating accommodation responses. Low-perceived efficacy over AN contributed to caregiver burnout. Decreased emotional resources influenced a shift in caregiving aims conducive with accommodation. Nevertheless, carers perceived accommodation as counterproductive to recovery and consequently experienced internal conflict (cognitive dissonance). Dissonance was reduced using a number of cognitive and behavioural strategies. The implications of these findings are discussed with reference to existing literature. Copyright © 2016 John Wiley & Sons, Ltd. Anorexia nervosa (AN) can be difficult to manage. Over time, carers can feel

  16. A Developmental View of Anorexia Nervosa.

    Science.gov (United States)

    Akeroyd-Guillory, Denise

    1988-01-01

    Conducted research, based on Erikson's theory of identity development, to examine anorexic's progression through early stages of development. Results support the view that the negative aspects of development are clearly present in the anorexic. Findings have implications for school counselors. Introductory questionnaire on anorexia is appended.…

  17. Unusual Presentation of Uncommon Disease: Anorexia Nervosa Presenting as Wernicke-Korsakoff Syndrome—A Case Report from Southeast Asia

    OpenAIRE

    Mushtaq, Raheel; Shoib, Sheikh; Shah, Tabindah; Bhat, Mudasir; Singh, Randhir; Mushtaq, Sahil

    2014-01-01

    Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa...

  18. [Neurocognitive and social cognition deficits in patients with anorexia nervosa].

    Science.gov (United States)

    Kułakowska, Dorota; Biernacka, Katarzyna; Wilkos, Ewelina; Rybakowski, Filip; Kucharska-Pietura, Katarzyna

    2014-01-01

    In the first part of the article the authors present a set of the actual concepts explaining problems of cognitive functions and social cognition currently observed in patients with anorexia nervosa (AN). It is possible; through the neuroimaging research, to get better understanding of the brain specifics in these individuals. Even though, the AN remains a disease with very complex and multifactorial etiology which remains a huge medical challenge. Currently, popular is the view that takes into consideration the integrating role of the insula and subcortical structures (such as hippocampus, amygdala, thalamus) in the regulation of cognitive and emotional processes in people suffering from AN. There is still an open problem, however, of the selection of therapeutic interventions targeting these deficits. The second part of the article presents the attempt to describe deficits in neurocognitive and social cognition in people with AN occurring prior to illness, during and after the recovery. Particular attention has been paid to the most frequently described in the literature--neurocognitive deficits such as rigidity of thinking, weak central coherence, and deficits in social cognition, including mental processes of perception and expression of emotions, disorders of the theory of mind (ToM) and empathy. The results of previous studies, their scarcity in Poland, do not give a satisfactory answer to the question whether the above mentioned disorders are a feature of endophenotype or condition in an episode of the disease. Research point to the more permanent nature, which may be more resistant to therapeutic modifications.

  19. The functional significance of shyness in anorexia nervosa.

    Science.gov (United States)

    Winecoff, Amy A; Ngo, Lawrence; Moskovich, Ashley; Merwin, Rhonda; Zucker, Nancy

    2015-07-01

    The defining features of anorexia nervosa (AN) include disordered eating and disturbance in the experience of their bodies; however, many women with AN also demonstrate higher harm avoidance (HA), lower novelty seeking, and challenges with interpersonal functioning. The current study explored whether HA and novelty seeking could explain variation in disordered eating and social functioning in healthy control women ( n = 18), weight-restored women with a history of AN (n = 17), and women currently-ill with AN (AN; n = 17). Our results indicated that clinical participants (AN + weight-restored women) reported poorer social skills than healthy control participants. Moreover, the relationship between eating disorder symptoms and social skill deficits was mediated by HA. Follow-up analyses indicated that only the 'shyness with strangers' factor of HA independently mediated this relationship. Collectively, our results suggest a better understanding of shyness in many individuals with eating disorders could inform models of interpersonal functioning in AN. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  20. Nutritional adequacy of dietary intake in women with anorexia nervosa.

    Science.gov (United States)

    Raatz, Susan K; Jahns, Lisa; Johnson, LuAnn K; Crosby, Ross; Mitchell, James E; Crow, Scott; Peterson, Carol; Le Grange, Daniel; Wonderlich, Stephen A

    2015-05-15

    Understanding nutrient intake of anorexia nervosa (AN) patients is essential for the treatment. Therefore, estimates of total energy and nutrient consumption were made in a group of young women (19 to 30 years) with restricting and binge purge subtypes of AN participating in an ecological momentary assessment study. Participants completed three nonconsecutive 24-hour diet recalls. Mean nutrient intakes were stratified by subtype and by quartiles of energy intake and compared to the age specific Dietary Reference Intake (DRI) levels, as well as to the reported intakes from the What We Eat In America (WWEIA) dietary survey 2011-2012. Reported intake was determined for energy, macronutrients, and micronutrients. The mean body mass index (BMI) for all participants was 17.2 ± 0.1 kg/m2. Reported nutrient intake was insufficient for participants in quartiles 1-3 of both AN subtypes when compared to the DRIs. Intake reported by participants in quartile 4 of both subgroups met requirements for most nutrients and even met or exceeded estimated energy needs. Counseling of AN patients should be directed to total food consumption to improve energy intake and to reduce individual nutritional gaps.

  1. Nutritional Adequacy of Dietary Intake in Women with Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Susan K. Raatz

    2015-05-01

    Full Text Available Understanding nutrient intake of anorexia nervosa (AN patients is essential for the treatment. Therefore, estimates of total energy and nutrient consumption were made in a group of young women (19 to 30 years with restricting and binge purge subtypes of AN participating in an ecological momentary assessment study. Participants completed three nonconsecutive 24-hour diet recalls. Mean nutrient intakes were stratified by subtype and by quartiles of energy intake and compared to the age specific Dietary Reference Intake (DRI levels, as well as to the reported intakes from the What We Eat In America (WWEIA dietary survey 2011–2012. Reported intake was determined for energy, macronutrients, and micronutrients. The mean body mass index (BMI for all participants was 17.2 ± 0.1 kg/m2. Reported nutrient intake was insufficient for participants in quartiles 1–3 of both AN subtypes when compared to the DRIs. Intake reported by participants in quartile 4 of both subgroups met requirements for most nutrients and even met or exceeded estimated energy needs. Counseling of AN patients should be directed to total food consumption to improve energy intake and to reduce individual nutritional gaps.

  2. A qualitative investigation into anorexia nervosa: The inner perspective

    Directory of Open Access Journals (Sweden)

    Enrica Marzola

    2015-12-01

    Full Text Available The ego-syntonic nature of anorexia nervosa (AN emphasizes how some aspects of this disorder can be highly valuable to patients. To understand the different perspectives that patients with AN hold about their condition, we explored the meanings they attribute to it. Thirty-four AN patients were asked to write a letter to their condition describing what it represents and means to them. Letters were then evaluated using a standardized coding scheme. Three pro-codes resulted to be mostly represented: difference (i.e. feeling different from others because of AN, company (i.e. being protected by the disorder, and identity (i.e. being totally represented by the illness. Some anti-codes were also particularly used: anger/hate, expressing anger toward AN, fear/distress, betrayal/pretend (i.e. feeling cheated by the disorder, and loss/waste (i.e. describing a feeling of life being wasted. In addition to pro- and anti-codes, the ambivalence theme was also well represented. Given the complex adaptive function of this disorder, this study may provide a framework of different perspectives that therapists could refer to and patients could identify with during the therapeutic process toward discovering individual meanings of the disorder.

  3. Neurobiochemical and psychological factors influencing the eating behaviors and attitudes in anorexia nervosa.

    Science.gov (United States)

    Grzelak, Teresa; Dutkiewicz, Agata; Paszynska, Elzbieta; Dmitrzak-Weglarz, Monika; Slopien, Agnieszka; Tyszkiewicz-Nwafor, Marta

    2017-05-01

    The aim of this study was to determine the characteristic features which contribute to inappropriate eating attitudes in people suffering from anorexia nervosa, based on an analysis of recent data. Factors influencing these attitudes have a genetic, neurobiological, biochemical, affective-motivational, cognitive, and behavioral background. Another important issue addressed in the paper is a description of the mechanism leading to continuous dietary restrictions. The altered activity of neurotransmitters modulating patients' moods after the consumption of food and a disturbed responsiveness to enterohormones enhance affective-motivational and cognitive aspects which, in turn, impede the improvement of eating behaviors. An understanding of the mechanisms behind the factors affecting the maintenance of inappropriate eating attitudes may contribute to greater effectiveness in the treatment of anorexia nervosa.

  4. Nutritional Therapy Leads To Complete Recovery of Left Ventricular Dysfunction in Anorexia Nervosa: A Case Report

    Directory of Open Access Journals (Sweden)

    Karan Wats

    2016-01-01

    Full Text Available This case highlights the cardiac complications associated with anorexia nervosa and how early recognition and treatment significantly affects overall prognosis. A few cases have been reported in literature where cardiomyopathy associated with anorexia nervosa was reported but this is the first case where adequate medical management and metabolic support lead to complete recovery.

  5. Coming Together to Calm the Hunger: Group Therapy Program for Adults Diagnosed with Anorexia Nervosa

    Science.gov (United States)

    Ponech, Heather; McBride, Dawn Lorraine

    2012-01-01

    This project provides a comprehensive overview of the research literature on anorexia nervosa in female adults and concludes by offering 14 group therapy lesson plans for anorexia nervosa that therapists may use in their practice. There is a remarkable lack of research on the efficacy of treatment designed for individuals diagnosed with anorexia…

  6. Translational neuroscience of anorexia nervosa: A genetic and environmental interplay underlying behavioural hyperactivity in mice

    NARCIS (Netherlands)

    Pjetri, E.

    2012-01-01

    Anorexia Nervosa is a severe mental illness, affecting young females more than males. Anorexia nervosa runs a chronic, relapsing course and is associated with high disability and mortality rates. The hallmark of the disease is keeping a low body weight, less than 85% of what is expected. The

  7. Anorexia Nervosa/Bulimia. LC Science Tracer Bullet, TB 85-8.

    Science.gov (United States)

    Halasz, Hisako, Comp.

    This bibliography is intended to help readers locate material on anorexia nervosa and bulimia in the collections of the Library of Congress. A scope note briefly defines the terms "anorexia nervosa" and "bulimia" and discusses similarities and differences between the two eating disorders. Four references are included as introductions to the topic…

  8. Bulimics with and without Prior Anorexia Nervosa: A Comparison of Personality Characteristics.

    Science.gov (United States)

    Katzman, Melanie A.; Wolchik, Sharlene A.

    A controversial issue in the literature on eating disorders is whether or not bulimia is a disorder distinct from anorexia nervosa. To compare the personality and behavioral characteristics of bulimic women with and without prior anorexia nervosa, 14 female college students (mean age 19.6 years, 86 percent white) were divided into two groups…

  9. Mental capacity to consent to treatment in anorexia nervosa : explorative study

    NARCIS (Netherlands)

    Elzakkers, Isis F F M; Danner, Unna N; Hoek, Hans W; van Elburg, Annemarie A

    2016-01-01

    BACKGROUND: Mental capacity to consent to treatment in anorexia nervosa is a neglected area in clinical decision-making. AIMS: To examine clinical and neuropsychological parameters associated with diminished mental capacity in anorexia nervosa. METHOD: An explorative study was conducted in 70 adult

  10. A Comparison of Short- And Long-Term Family Therapy for Adolescent Anorexia Nervosa.

    Science.gov (United States)

    Lock, James; Agras, W. Stewart; Bryson, Susan; Kraemer, Helena C.

    2005-01-01

    Objective: Research suggests that family treatment for adolescents with anorexia nervosa may be effective. This study was designed to determine the optimal length of such family therapy. Method: Eighty-six adolescents (12-18 years of age) diagnosed with anorexia nervosa were allocated at random to either a short-term (10 sessions over 6 months) or…

  11. Recovery of Normal Body Weight in Adolescents with Anorexia Nervosa: The Nurses’ Perspective on Effective Interventions

    NARCIS (Netherlands)

    Annemarie van Elburg; prof Berno van Meijel; Esther Meerwijk; Laura Beukers; Joyce van Ommen; René Bakker

    2011-01-01

    Little is known about effective nursing interventions for adolescents with anorexia nervosa. The purpose of this study was to discover which aspects of nursing care are most effective, according to nurses, in recovery of normal body weight in adolescents with anorexia nervosa. METHODS: A qualitative

  12. Testing the Hypothesis of the Multidimensional Model of Anorexia Nervosa in Adolescents.

    Science.gov (United States)

    Lyon, Maureen; Chatoor, Irene; Atkins, Darlene; Silber, Tomas; Mosimann, James; Gray, James

    1997-01-01

    Tested six hypothesized risk factors of a model for anorexia nervosa. Results confirmed three of the risk factors: family history of depression, feelings of ineffectiveness, and poor interceptive awareness. Alcohol and drug abuse also figured prominently in the family history of patients with anorexia nervosa. (RJM)

  13. The DSM-5 diagnostic criteria for anorexia nervosa may change its population prevalence and prognostic value

    NARCIS (Netherlands)

    Mustelin, Linda; Silen, Yasmina; Raevuori, Anu; Hoek, Hans W.; Kaprio, Jaakko; Keski-Rahkonen, Anna

    The definition of anorexia nervosa was revised for the Fifth Edition of the Diagnostic and Statistical Manual (DSM-5). We examined the impact of these changes on the prevalence and prognosis of anorexia nervosa. In a nationwide longitudinal study of Finnish twins born 1975-1979, the women (N = 2825)

  14. Avaliação da microbiota bucal de pacientes com anorexia nervosa e bulimia nervosa

    OpenAIRE

    Brito, Graziella Nuernberg Back [UNESP

    2009-01-01

    Os Transtornos alimentares (TA) como Anorexia Nervosa (AN) e Bulimia Nervosa (BN) são acompanhados de inúmeras alterações sistêmicas e bucais relacionadas ao comprometimento do estado nutricional e às práticas compensatórias inadequadas para o controle do peso. O objetivo deste estudo foi avaliar diversidade microbiológica existente na cavidade bucal de pacientes com estes transtornos, por meio de técnicas de cultivo e utilizando métodos moleculares independentes de cultivo. Foram incluídos n...

  15. Restoring normal eating behaviour in adolescents with anorexia nervosa: A video analysis of nursing interventions.

    Science.gov (United States)

    Beukers, Laura; Berends, Tamara; de Man-van Ginkel, Janneke M; van Elburg, Annemarie A; van Meijel, Berno

    2015-12-01

    An important part of inpatient treatment for adolescents with anorexia nervosa is to restore normal eating behaviour. Health-care professionals play a significant role in this process, but little is known about their interventions during patients' meals. The purpose of the present study was to describe nursing interventions aimed at restoring normal eating behaviour in patients with anorexia nervosa. The main research question was: 'Which interventions aimed at restoring normal eating behaviour do health-care professionals in a specialist eating disorder centre use during meal times for adolescents diagnosed with anorexia nervosa? The present study was a qualitative, descriptive study that used video recordings made during mealtimes. Thematic data analysis was applied. Four categories of interventions emerged from the data: (i) monitoring and instructing; (ii) encouraging and motivating; (iii) supporting and understanding; and (iv) educating. The data revealed a directive attitude aimed at promoting behavioural change, but always in combination with empathy and understanding. In the first stage of clinical treatment, health-care professionals focus primarily on changing patients' eating behaviour. However, they also address the psychosocial needs that become visible in patients as they struggle to restore normal eating behaviour. The findings of the present study can be used to assist health-care professionals, and improve multidisciplinary guidelines and health-care professionals' training programmes. © 2015 Australian College of Mental Health Nurses Inc.

  16. Association of CNR1 and FAAH endocannabinoid gene polymorphisms with anorexia nervosa and bulimia nervosa: evidence for synergistic effects.

    Science.gov (United States)

    Monteleone, P; Bifulco, M; Di Filippo, C; Gazzerro, P; Canestrelli, B; Monteleone, F; Proto, M C; Di Genio, M; Grimaldi, C; Maj, M

    2009-10-01

    Endocannabinoids modulate eating behavior; hence, endocannabinoid genes may contribute to the biological vulnerability to eating disorders. The rs1049353 (1359 G/A) single nucleotide polymorphism (SNP) of the gene coding the endocannabinoid CB1 receptor (CNR1) and the rs324420 (cDNA 385C to A) SNP of the gene coding fatty acid amide hydrolase (FAAH), the major degrading enzyme of endocannabinoids, have been suggested to have functional effects on mature proteins. Therefore, we explored the possibility that those SNPs were associated to anorexia nervosa and/or bulimia nervosa. The distributions of the CNR1 1359 G/A SNP and of the FAAH cDNA 385C to A SNP were investigated in 134 patients with anorexia nervosa, 180 patients with bulimia nervosa and 148 normal weight healthy controls. Additive effects of the two SNPs in the genetic susceptibility to anorexia nervosa and bulimia nervosa were also tested. As compared to healthy controls, anorexic and bulimic patients showed significantly higher frequencies of the AG genotype and the A allele of the CNR1 1359 G/A SNP. Similarly, the AC genotype and the A allele of the FAAH cDNA 385C to A SNP were significantly more frequent in anorexic and bulimic individuals. A synergistic effect of the two SNPs was evident in anorexia nervosa but not in bulimia nervosa. Present findings show for the first time that the CNR1 1359 G/A SNP and the FAAH cDNA 385C to A SNP are significantly associated to anorexia nervosa and bulimia nervosa, and demonstrate a synergistic effect of the two SNPs in anorexia nervosa.

  17. [Anorexia nervosa in light of Karl Jaspers and Erich Fromm's ideas and social constructivism--hypotheses and thoughts].

    Science.gov (United States)

    Talarczyk, Małgorzata

    2012-01-01

    The point of the article is to analyse and reflect on certain symptoms of anorexia nervosa in light of Karl Jaspers and Erich Fromm's ideas and social constructivism. Contemplating the disorder in view of the philosophical ideas mentioned earlier, the author analyses such aspects of patients as: functioning on the verge of life and death, the paradoxical struggle to escape from freedom in search of independence, as well as various understandings and descriptions of anorexia in consideration of social constructivism. The author shares thoughts and poses hypotheses, trying to view anorexia in light of selected philosophical and psychological ideas, which in their general assumptions were not concerned with defining nor analysing anorexia nervosa. In view of Karl Jaspers' ideas, the author focuses on the so called 'limit-situations', in the ideas of Erich Fromm she takes notice in "Escape from Freedom" to new relations. Finally in the light of social constructivism the author focuses on the cultural context.

  18. Patterns of medical utilization before the first hospitalization for women with anorexia nervosa in Taiwan.

    Science.gov (United States)

    Hung, Yen-Ni; Kuo, Chian-Jue; Yang, Shu-Yu; Huang, Ming-Chyi; Chen, Ying-Yeh; Lin, Shih-Ku; Chen, Kuan-Yu

    2017-11-01

    The aim of this paper was to analyze medical utilization patterns of female patients with anorexia nervosa before their first inpatient care visit for anorexia nervosa using the National Health Insurance Research Database (NHIRD) of Taiwan. We selected female anorexia nervosa patients (n=239) and control participants hospitalized for peptic ulcers (n=478) or appendectomy (n=478) who were matched by age and incident year from two subsets of the NHIRD. The number of visits, specialists, diagnosis distribution, and selected procedures used in ambulatory services during the 2-year period before the index admission were identified and compared. Healthcare service expenditures were also analyzed. Compared to the control groups, the female anorexia nervosa patients used more outpatient services (anorexia nervosa, 58.6±45.0 visits; peptic ulcers, 45.3±37.3 visits; appendectomy, 32.5±26.0 visits), mainly due to psychiatric visits. Anorexia nervosa patients were more likely to have received a diagnosis of digestive, endocrine/metabolic, and mental disorders than patients in the control groups. Although nearly equal percentages of patients in the three groups had obtained a diagnosis of a digestive disease, anorexia nervosa patients received digestive disease diagnoses with greater frequency. We posit that the various physical symptoms of anorexia nervosa patients and physicians' low level of suspicion of anorexia nervosa led to delayed diagnoses and greater medical utilization than that of the controls groups. Education to raise awareness of anorexia nervosa and other eating disorders among physicians is warranted. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Psychiatrists' attitudes towards autonomy, best interests and compulsory treatment in anorexia nervosa: a questionnaire survey

    Directory of Open Access Journals (Sweden)

    Stewart Anne

    2008-12-01

    Full Text Available Abstract Background The compulsory treatment of anorexia nervosa is a contentious issue. Research suggests that psychiatrists have a range of attitudes towards patients suffering from anorexia nervosa, and towards the use of compulsory treatment for the disorder. Methods A postal self-completed attitudinal questionnaire was sent to senior psychiatrists in the United Kingdom who were mostly general adult psychiatrists, child and adolescent psychiatrists, or psychiatrists with an interest in eating disorders. Results Respondents generally supported a role for compulsory measures under mental health legislation in the treatment of patients with anorexia nervosa. Compared to 'mild' anorexia nervosa, respondents generally were less likely to feel that patients with 'severe' anorexia nervosa were intentionally engaging in weight loss behaviours, were able to control their behaviours, wanted to get better, or were able to reason properly. However, eating disorder specialists were less likely than other psychiatrists to think that patients with 'mild' anorexia nervosa were choosing to engage in their behaviours or able to control their behaviours. Child and adolescent psychiatrists were more likely to have a positive view of the use of parental consent and compulsory treatment for an adolescent with anorexia nervosa. Three factors emerged from factor analysis of the responses named: 'Support for the powers of the Mental Health Act to protect from harm'; 'Primacy of best interests'; and 'Autonomy viewed as being preserved in anorexia nervosa'. Different scores on these factor scales were given in terms of type of specialist and gender. Conclusion In general, senior psychiatrists tend to support the use of compulsory treatment to protect the health of patients at risk and also to protect the welfare of patients in their best interests. In particular, eating disorder specialists tend to support the compulsory treatment of patients with anorexia nervosa

  20. The Use of Animal Models to Decipher Physiological and Neurobiological Alterations of Anorexia Nervosa Patients

    Science.gov (United States)

    Méquinion, Mathieu; Chauveau, Christophe; Viltart, Odile

    2015-01-01

    Extensive studies were performed to decipher the mechanisms regulating feeding due to the worldwide obesity pandemy and its complications. The data obtained might be adapted to another disorder related to alteration of food intake, the restrictive anorexia nervosa. This multifactorial disease with a complex and unknown etiology is considered as an awful eating disorder since the chronic refusal to eat leads to severe, and sometimes, irreversible complications for the whole organism, until death. There is an urgent need to better understand the different aspects of the disease to develop novel approaches complementary to the usual psychological therapies. For this purpose, the use of pertinent animal models becomes a necessity. We present here the various rodent models described in the literature that might be used to dissect central and peripheral mechanisms involved in the adaptation to deficient energy supplies and/or the maintenance of physiological alterations on the long term. Data obtained from the spontaneous or engineered genetic models permit to better apprehend the implication of one signaling system (hormone, neuropeptide, neurotransmitter) in the development of several symptoms observed in anorexia nervosa. As example, mutations in the ghrelin, serotonin, dopamine pathways lead to alterations that mimic the phenotype, but compensatory mechanisms often occur rendering necessary the use of more selective gene strategies. Until now, environmental animal models based on one or several inducing factors like diet restriction, stress, or physical activity mimicked more extensively central and peripheral alterations decribed in anorexia nervosa. They bring significant data on feeding behavior, energy expenditure, and central circuit alterations. Animal models are described and criticized on the basis of the criteria of validity for anorexia nervosa. PMID:26042085

  1. The use of animal models to decipher physiological and neurobiological alterations of anorexia nervosa patients.

    Science.gov (United States)

    Méquinion, Mathieu; Chauveau, Christophe; Viltart, Odile

    2015-01-01

    Extensive studies were performed to decipher the mechanisms regulating feeding due to the worldwide obesity pandemy and its complications. The data obtained might be adapted to another disorder related to alteration of food intake, the restrictive anorexia nervosa. This multifactorial disease with a complex and unknown etiology is considered as an awful eating disorder since the chronic refusal to eat leads to severe, and sometimes, irreversible complications for the whole organism, until death. There is an urgent need to better understand the different aspects of the disease to develop novel approaches complementary to the usual psychological therapies. For this purpose, the use of pertinent animal models becomes a necessity. We present here the various rodent models described in the literature that might be used to dissect central and peripheral mechanisms involved in the adaptation to deficient energy supplies and/or the maintenance of physiological alterations on the long term. Data obtained from the spontaneous or engineered genetic models permit to better apprehend the implication of one signaling system (hormone, neuropeptide, neurotransmitter) in the development of several symptoms observed in anorexia nervosa. As example, mutations in the ghrelin, serotonin, dopamine pathways lead to alterations that mimic the phenotype, but compensatory mechanisms often occur rendering necessary the use of more selective gene strategies. Until now, environmental animal models based on one or several inducing factors like diet restriction, stress, or physical activity mimicked more extensively central and peripheral alterations decribed in anorexia nervosa. They bring significant data on feeding behavior, energy expenditure, and central circuit alterations. Animal models are described and criticized on the basis of the criteria of validity for anorexia nervosa.

  2. The use of animal models to decipher physiological and neurobiological alterations of Anorexia Nervosa patients.

    Directory of Open Access Journals (Sweden)

    Mathieu eMéquinion

    2015-05-01

    Full Text Available Extensive studies were performed to decipher the mechanisms regulating feeding due to the worldwide obesity pandemy and its complications. The data obtained might be adapted to another disorder related to alteration of food intake, the restrictive anorexia nervosa. This multifactorial disease with a complex and unknown etiology is considered as an awful eating disorder since the chronic refusal to eat leads to severe and sometimes irreversible complications for the whole organism, until death. There is an urgent need to better understand the different aspects of the disease to develop novel approaches complementary to the usual psychological therapies. For this purpose, the use of pertinent animal models becomes a necessity. We present here the various rodent models described in the literature that might be used to dissect central and peripheral mechanisms involved in the adaptation to deficient energy supplies and/or the maintenance of physiological alterations on the long term. Data obtained from the spontaneous or engineered genetic models permit to better apprehend the implication of one signaling system (hormone, neuropeptides, neurotransmitter in the development of several symptoms observed in anorexia nervosa. As example, mutations in the ghrelin, serotonin, dopamine pathways lead to alterations that mimic the phenotype, but compensatory mechanisms often occur rendering necessary the used of more selective gene strategies. Until now, environmental animal models based on one or several inducing factors like diet restriction, stress or physical activity mimicked more extensively central and peripheral alterations decribed in anorexia nervosa. They bring significant data on feeding behavior, energy expenditure and central circuit alterations. Animal models are described and criticized on the basis of the criteria of validity for anorexia nervosa.

  3. Anorexia Nervosa and Its Long-term Impact on Treated Patients

    OpenAIRE

    Štolfová, Lucie

    2014-01-01

    TITLE: Anorexia Nervosa and Its Long-term Impact on Treated Patients AUTHOR: Lucie Štolfová DEPARTMENT: Department of Education SUPERVIZOR: PeaDr. Eva Marádová, CSc. ABSTRACT: This bachelor thesis deals with the psychiatric disorder called anorexia nervosa. The thesis aims to highlight the signs and symptoms, which are particularly characteristic for this kind of eating disorder. The most important goal is to prove that anorexia is a chronic disorder, lasting perhaps several years to decades....

  4. [Prevalence of anorexia nervosa, bulimia nervosa and other eating disorders in adolescent girls in Reus (Spain)].

    Science.gov (United States)

    Olesti Baiges, M; Piñol Moreso, J L; Martín Vergara, N; de la Fuente García, M; Riera Solé, A; Bofarull Bosch, J Maria; Ricomá de Castellarnau, G

    2008-01-01

    Eating disorders are characterized by changes in eating patterns associated with a series of psychosocial conflicts, low self-esteem and poor empathy, and an obsession with slimming. The aims of the present study were: 1. To determinate the prevalence of anorexia nervosa, bulimia nervosa and other eating disorders in a representative sample of adolescent girls between the ages of 12 and 21 living in the city of Reus (Spain). 2. To evaluate the association between eating disorders and alterations on the Eating Attitudes Test-40 (EAT-40), Body Attitudes Test (BAT), and the Aesthetic Body Shape Questionnaire (CIMEC). We performed a cross-sectional observational study in a random sample of adolescent girls aged between 12 and 21 years old. Information was gathered from a structured questionnaire on demographic and anthropometric factors (age, place of birth, education, etc.), clinical examination, clinical interview, DMS-IV diagnostic criteria, and three self-administered tests: EAT-40, BAT and CIMEC. A total of 551 adolescents were analyzed. The mean age was 17.6+/-2.5 years. Diagnostic criteria of anorexia nervosa were found in 0.9% (95% CI: 0.4-2.4), bulimia nervosa in 2.9% (95% CI: 1.7-4.7), and other eating disorders in 5.3% (95% CI: 3.6-7.5). The test showing the greatest alterations was the CIMEC (38%), followed by the BAT (27.1%) and EAT-40 (23.1%). All the adolescents that met the diagnostic criteria of anorexia nervosa showed alterations in all three tests. The high prevalence of eating disorders indicates the need for greater direct involvement among health professionals. The EAT-40, BAT and CIMEC are effective screening instruments for these disorders.

  5. Heightened fear of uncertainty in anorexia and bulimia nervosa.

    Science.gov (United States)

    Frank, Guido K W; Roblek, Tami; Shott, Megan E; Jappe, Leah M; Rollin, Michael D H; Hagman, Jennifer O; Pryor, Tamara

    2012-03-01

    To test whether intolerance of uncertainty (IU) is related to eating disorder (ED) pathology. Thirty individuals with anorexia nervosa (AN), 19 with bulimia nervosa (BN), and 28 healthy control women (CW) completed the Intolerance of Uncertainty Scale (IUS). AN and BN groups showed higher IU compared with CW. In AN and BN, Harm Avoidance and Depression scores were positively correlated with IU. In AN but not BN, IU was related positively to Drive for Thinness and Body Dissatisfaction. Elevated IU is associated with AN and BN. Anxious traits may be inherent in EDs and IU could be a developmental factor contributing to anxiety, mood, and ED behavior in AN and BN. Copyright © 2011 Wiley Periodicals, Inc.

  6. Heightened Fear of Uncertainty in Anorexia and Bulimia Nervosa

    Science.gov (United States)

    Frank, Guido K.W.; Roblek, Tami; Shott, Megan E.; Jappe, Leah M.; Rollin, Michael D.H.; Hagman, Jennifer O.; Pryor, Tamara

    2011-01-01

    Objective To test whether intolerance of uncertainty (IU) is related to eating disorder (ED) pathology. Method Thirty individuals with anorexia nervosa (AN), 19 with bulimia nervosa (BN) and 28 healthy control women (CW) completed the Intolerance of Uncertainty Scale (IUS). Results AN and BN groups showed higher IU compared to CW. In AN and BN, Harm Avoidance and Depression scores were positively correlated with IU. In AN but not BN, IU was related positively to Drive for Thinness and Body Dissatisfaction. Conclusion Elevated IU is associated with AN and BN. Anxious traits may be inherent in EDs and IU could be a developmental factor contributing to anxiety, mood and ED behavior in AN and BN. PMID:21495057

  7. Altered insula response to sweet taste processing after recovery from anorexia and bulimia nervosa.

    Science.gov (United States)

    Oberndorfer, Tyson A; Frank, Guido K W; Simmons, Alan N; Wagner, Angela; McCurdy, Danyale; Fudge, Julie L; Yang, Tony T; Paulus, Martin P; Kaye, Walter H

    2013-10-01

    Recent studies suggest that altered function of higher-order appetitive neural circuitry may contribute to restricted eating in anorexia nervosa and overeating in bulimia nervosa. This study used sweet tastes to interrogate gustatory neurocircuitry involving the anterior insula and related regions that modulate sensory-interoceptive-reward signals in response to palatable foods. Participants who had recovered from anorexia nervosa and bulimia nervosa were studied to avoid confounding effects of altered nutritional state. Functional MRI measured brain response to repeated tastes of sucrose and sucralose to disentangle neural processing of caloric and noncaloric sweet tastes. Whole-brain functional analysis was constrained to anatomical regions of interest. Relative to matched comparison women (N=14), women recovered from anorexia nervosa (N=14) had significantly diminished and women recovered from bulimia nervosa (N=14) had significantly elevated hemodynamic response to tastes of sucrose in the right anterior insula. Anterior insula response to sucrose compared with sucralose was exaggerated in the recovered group (lower in women recovered from anorexia nervosa and higher in women recovered from bulimia nervosa). The anterior insula integrates sensory reward aspects of taste in the service of nutritional homeostasis. One possibility is that restricted eating and weight loss occur in anorexia nervosa because of a failure to accurately recognize hunger signals, whereas overeating in bulimia nervosa could represent an exaggerated perception of hunger signals. This response may reflect the altered calibration of signals related to sweet taste and the caloric content of food and may offer a pathway to novel and more effective treatments.

  8. Electrocortical processing of food and emotional pictures in anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Blechert, Jens; Feige, Bernd; Joos, Andreas; Zeeck, Almut; Tuschen-Caffier, Brunna

    2011-06-01

    Objective To compare the electrocortical processing of food pictures in participants with anorexia nervosa (n = 21), bulimia nervosa (n = 22), and healthy controls (HCs) (n = 32) by measuring the early posterior negativity, an event-related potential that reflects stimulus salience and selective attention. Methods We exposed these three groups to a rapid stream of high- and low-calorie food pictures, as well as standard emotional and neutral pictures. Results Event-related potentials in the time range of 220 milliseconds to 310 milliseconds on posterior electrodes differed between groups: patients with eating disorders showed facilitated processing of both high- and low-calorie food pictures relative to neutral pictures, whereas HC participants did so only for the high-calorie pictures. Subjective palatability of the pictures was rated highest by patients with anorexia nervosa, followed by the HC and bulimia nervosa groups. Conclusions Patients with eating disorders show a generalized attentional bias for food images, regardless of caloric value. This might explain the persistent preoccupation with food in these individuals.

  9. Hypovitaminosis D3, Leukopenia, and Human Serotonin Transporter Polymorphism in Anorexia Nervosa and Bulimia Nervosa

    Directory of Open Access Journals (Sweden)

    Anna Tasegian

    2016-01-01

    Full Text Available Vitamin D3 has been described to have different extraskeletal roles by acting as parahormone in obesity, diabetes, cancer, cognitive impairment, and dementia and to have important regulatory functions in innate immunity. There are no studies showing extraskeletal changes associated with hypovitaminosis D3 in eating disorders. Methods. We have analyzed the blood of 18 patients affected by anorexia nervosa and bulimia nervosa collected over a 15-month period. We performed a panel of chemical and clinical analyses: the assay of vitamin D3, the immunoblotting of vitamin D receptor and peroxisome proliferator-activated receptor gamma, and the genotyping of 5-hydroxytryptamine transporter linked polymorphic region. Results. We choose 18 patients with a normal blood test profile such as thyroid hormones, hepatic and renal parameters, triglycerides, proteins, vitamin B12, and folic acid. Among these emerged the case of a woman with long-term anorexia nervosa and the case of a woman with long-term bulimia nervosa both complicated by anxiety and depression, severe hypovitaminosis D3, decrease of vitamin D receptor, leukopenia, and 5-hydroxytryptamine transporter linked polymorphic region short allele. Conclusion. The results induce hypothesising that the severe hypovitaminosis D3 might be responsible for the lack of the inflammatory response and the depressive symptoms in patients with long-term eating disorders.

  10. Hypovitaminosis D3, Leukopenia, and Human Serotonin Transporter Polymorphism in Anorexia Nervosa and Bulimia Nervosa.

    Science.gov (United States)

    Tasegian, Anna; Curcio, Francesco; Dalla Ragione, Laura; Rossetti, Francesca; Cataldi, Samuela; Codini, Michela; Ambesi-Impiombato, Francesco Saverio; Beccari, Tommaso; Albi, Elisabetta

    2016-01-01

    Vitamin D3 has been described to have different extraskeletal roles by acting as parahormone in obesity, diabetes, cancer, cognitive impairment, and dementia and to have important regulatory functions in innate immunity. There are no studies showing extraskeletal changes associated with hypovitaminosis D3 in eating disorders. Methods. We have analyzed the blood of 18 patients affected by anorexia nervosa and bulimia nervosa collected over a 15-month period. We performed a panel of chemical and clinical analyses: the assay of vitamin D3, the immunoblotting of vitamin D receptor and peroxisome proliferator-activated receptor gamma, and the genotyping of 5-hydroxytryptamine transporter linked polymorphic region. Results. We choose 18 patients with a normal blood test profile such as thyroid hormones, hepatic and renal parameters, triglycerides, proteins, vitamin B12, and folic acid. Among these emerged the case of a woman with long-term anorexia nervosa and the case of a woman with long-term bulimia nervosa both complicated by anxiety and depression, severe hypovitaminosis D3, decrease of vitamin D receptor, leukopenia, and 5-hydroxytryptamine transporter linked polymorphic region short allele. Conclusion. The results induce hypothesising that the severe hypovitaminosis D3 might be responsible for the lack of the inflammatory response and the depressive symptoms in patients with long-term eating disorders.

  11. Radionuclide study of gastric emptying in anorexia nervosa patients

    International Nuclear Information System (INIS)

    Shih, W.J.; Domstad, P.A.; Humphries, L.; Castellanos, F.X.; De Land, F.H.

    1986-01-01

    To evaluate gastric emptying, 20 patients with anorexia nervosa were given 150 μCi of Tc-99m triethylene tetraamine polystyrene resin in cereal and were imaged in the supine position. Data were accumulated at 5-minute intervals to determine the gastric emptying time (GET). The GET results were divided into three categories: prolonged (10 patients); rapid (eight); and normal (two). Although all patients had symptoms of gastric dysfunction, only 50% had prolonged GET. This study allows the objective documentation of gastric emptying and the separation of patients with rapid or normal GET from those with prolonged GET, who might benefit from metoclopramide

  12. Altered medial frontal feedback learning signals in anorexia nervosa

    OpenAIRE

    Bernardoni, Fabio; Geisler, Daniel; King, Joseph A.; Javadi, Amir-Homayoun; Ritschel, Franziska; Murr, Julia; Reiter, Andrea M.F.; Rössner, Veit; Smolka, Michael N.; Kiebel, Stefan; Ehrlich, Stefan

    2017-01-01

    Background\\ud \\ud In their relentless pursuit of thinness, individuals with anorexia nervosa (AN) engage in maladaptive behaviors (restrictive food choices, over-exercising) which may originate in altered decision-making and learning.\\ud \\ud Methods\\ud \\ud In this fMRI study we employed computational modelling to elucidate the neural correlates of feedback learning and value-based decision making in 36 female AN patients and 36 age-matched healthy volunteers (12-24 years). Participants perfor...

  13. Psychological inflexibility and symptom expression in anorexia nervosa.

    Science.gov (United States)

    Merwin, Rhonda M; Timko, C Alix; Moskovich, Ashley A; Ingle, Krista Konrad; Bulik, Cynthia M; Zucker, Nancy L

    2011-01-01

    The purpose of this article is to outline a model of anorexia nervosa (AN) as a disorder of psychological inflexibility, motivated by an insatiable desire for prediction and control with related intolerance for uncertainty. We describe preliminary data that provide initial support for this conceptualization and point to the ways in which mindfulness and acceptance-based strategies might be particularly useful for treating AN. This article is not intended to be an exhaustive literature review, rather a conceptual framework to guide future research and treatment development.

  14. Processo de Enfermagem para pacientes com Anorexia Nervosa

    OpenAIRE

    Toledo, Vanessa Pellegrino; Ramos, Natália Amorim; Wopereis, Flávia

    2011-01-01

    Relato de experiência da aplicação do Processo de Enfermagem a uma paciente portadora de Anorexia Nervosa, utilizando histórico, diagnósticos, intervenções e resultados de enfermagem. As intervenções foram fundamentadas nos diagnósticos de enfermagem: distúrbio da imagem corporal, nutrição desequilibrada menos que as necessidades corporais, ansiedade, baixa autoestima crônica, intolerância a atividade, controle ineficaz do regime terapêutico, risco de infecção, volume de líquidos deficiente e...

  15. Anorexia nervosa ses ofte sammen medandre psykiatriske lidelser

    DEFF Research Database (Denmark)

    Panchenko, Anna; Arnfred, Sidse Marie Hemmingsen

    2015-01-01

    , depression, emotional instability/borderline and dependency disorders are most frequent. Psychopharmacological treatment could be tried in cases with AN and co-morbid depression, but otherwise the evidence base is lacking and pharmacological treatment relies on case stories and experience.......Recent literature is explored focusing on the relationship between symptoms of anorexia nervosa (AN) and other psychiatric disorders and lines of treatment. In AN, restrictive subtype, anxiety and obsessive-compulsive disorders are the most frequent co-morbidities. In AN, bulimic subtype...

  16. Dying To Be Thin: Attachment to Death in Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Yael Latzer

    2005-01-01

    Full Text Available Anorexia Nervosa (AN usually follows a prolonged course accompanied by significant morbidity and high mortality. AN patients have been found to have elevated and attempted suicide rates, with suicide being the second most common cause of death in AN after the complications of the disorder itself. The suicide risk in AN is similar to that in major depression or conduct disorder and linked mainly to longer duration of illness, lower weight, bingeing and purging, impulsivity-related manifestations, comorbid substance abuse, and affective disorder. This paper reviews suicidal tendency and disturbed body image, death and eating disorders, and attachment and death with clinical implications related to AN.

  17. Neuroendokrine forstyrrelser ved anorexia nervosa - primoere eller sekundoere?

    DEFF Research Database (Denmark)

    Støving, R K; Hansen-Nord, M; Hangaard, J

    1996-01-01

    or etiologic. Feeding behaviour in anorexia nervosa is characterised by a strong ambivalence and not by loss of appetite. Hypothalamic amenorrhea is a diagnostic criterion, and is not only secondary as it often precedes the weight loss and persists for a long time after weight and motor activity have returned...... deprivation. In conclusion most of the neuroendocrine abnormalities are secondary to weight loss, but some of them seem to participate in a circulus vitiosus and maintain the emaciated state. Udgivelsesdato: 1996-Dec-2...... to normal. Hypersecretion of corticotropin releasing hormone seems to be secondary to starvation, but at the same time it may keep up and intensify the anorexia, physical hyperactivity and amenorrhea. Low production of insulinlike growth factor-I and high growth hormone secretion reflects the nutritional...

  18. Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders--a nationwide register study

    DEFF Research Database (Denmark)

    Vestergaard, Peter; Emborg, Charlotte; Støving, René K

    2002-01-01

    OBJECTIVE: To study fracture risk in patients with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorders not otherwise specified (EDNOS). METHOD: Cohort study including all Danes diagnosed with AN (n = 2,149), BN (n = 1,294), or EDNOS (n = 942) between 1977 and 1998. Each patient...

  19. Review of Studies on the Relationships between Anorexia Nervosa, Bulimia Nervosa Tendency, Self Image, Body Image, and Sex-role

    OpenAIRE

    鈴木, 真理江

    1995-01-01

    In this study, the researches on relationships between anorexia nervosa, bulimia nervosa, self image, body image, and sex role were reviewed. The etiology of eating disorder has been said to be multidimensional. We need to consider the relationships between these factors which constitute the multidimensional model.

  20. Alterations in brain structures related to taste reward circuitry in ill and recovered anorexia nervosa and in bulimia nervosa.

    Science.gov (United States)

    Frank, Guido K; Shott, Megan E; Hagman, Jennifer O; Mittal, Vijay A

    2013-10-01

    The pathophysiology of anorexia nervosa remains obscure, but structural brain alterations could be functionally important biomarkers. The authors assessed taste pleasantness and reward sensitivity in relation to brain structure, which may be related to food avoidance commonly seen in eating disorders. The authors used structural MR imaging to study gray and white matter volumes in women with current restricting-type anorexia nervosa (N=19), women recovered from restricting-type anorexia nervosa (N=24), women with bulimia nervosa (N=19), and healthy comparison women (N=24). All eating disorder groups exhibited increased gray matter volume of the medial orbitofrontal cortex (gyrus rectus). Manual tracing confirmed larger gyrus rectus volume, and volume predicted taste pleasantness ratings across all groups. Analyses also indicated other morphological differences between diagnostic categories. Antero-ventral insula gray matter volumes were increased on the right side in the anorexia nervosa and recovered anorexia nervosa groups and on the left side in the bulimia nervosa group relative to the healthy comparison group. Dorsal striatum volumes were reduced in the recovered anorexia nervosa and bulimia nervosa groups and predicted sensitivity to reward in all three eating disorder groups. The eating disorder groups also showed reduced white matter in right temporal and parietal areas relative to the healthy comparison group. The results held when a range of covariates, such as age, depression, anxiety, and medications, were controlled for. Brain structure in the medial orbitofrontal cortex, insula, and striatum is altered in eating disorders and suggests altered brain circuitry that has been associated with taste pleasantness and reward value.

  1. Abnormal white matter properties in adolescent girls with anorexia nervosa.

    Science.gov (United States)

    Travis, Katherine E; Golden, Neville H; Feldman, Heidi M; Solomon, Murray; Nguyen, Jenny; Mezer, Aviv; Yeatman, Jason D; Dougherty, Robert F

    2015-01-01

    Anorexia nervosa (AN) is a serious eating disorder that typically emerges during adolescence and occurs most frequently in females. To date, very few studies have investigated the possible impact of AN on white matter tissue properties during adolescence, when white matter is still developing. The present study evaluated white matter tissue properties in adolescent girls with AN using diffusion MRI with tractography and T1 relaxometry to measure R1 (1/T1), an index of myelin content. Fifteen adolescent girls with AN (mean age = 16.6 years ± 1.4) were compared to fifteen age-matched girls with normal weight and eating behaviors (mean age = 17.1 years ± 1.3). We identified and segmented 9 bilateral cerebral tracts (18) and 8 callosal fiber tracts in each participant's brain (26 total). Tract profiles were generated by computing measures for fractional anisotropy (FA) and R1 along the trajectory of each tract. Compared to controls, FA in the AN group was significantly decreased in 4 of 26 white matter tracts and significantly increased in 2 of 26 white matter tracts. R1 was significantly decreased in the AN group compared to controls in 11 of 26 white matter tracts. Reduced FA in combination with reduced R1 suggests that the observed white matter differences in AN are likely due to reductions in myelin content. For the majority of tracts, group differences in FA and R1 did not occur within the same tract. The present findings have important implications for understanding the neurobiological factors underlying white matter changes associated with AN and invite further investigations examining associations between white matter properties and specific physiological, cognitive, social, or emotional functions affected in AN.

  2. Abnormal white matter properties in adolescent girls with anorexia nervosa

    Directory of Open Access Journals (Sweden)

    Katherine E. Travis

    2015-01-01

    Full Text Available Anorexia nervosa (AN is a serious eating disorder that typically emerges during adolescence and occurs most frequently in females. To date, very few studies have investigated the possible impact of AN on white matter tissue properties during adolescence, when white matter is still developing. The present study evaluated white matter tissue properties in adolescent girls with AN using diffusion MRI with tractography and T1 relaxometry to measure R1 (1/T1, an index of myelin content. Fifteen adolescent girls with AN (mean age = 16.6 years ± 1.4 were compared to fifteen age-matched girls with normal weight and eating behaviors (mean age = 17.1 years ± 1.3. We identified and segmented 9 bilateral cerebral tracts (18 and 8 callosal fiber tracts in each participant's brain (26 total. Tract profiles were generated by computing measures for fractional anisotropy (FA and R1 along the trajectory of each tract. Compared to controls, FA in the AN group was significantly decreased in 4 of 26 white matter tracts and significantly increased in 2 of 26 white matter tracts. R1 was significantly decreased in the AN group compared to controls in 11 of 26 white matter tracts. Reduced FA in combination with reduced R1 suggests that the observed white matter differences in AN are likely due to reductions in myelin content. For the majority of tracts, group differences in FA and R1 did not occur within the same tract. The present findings have important implications for understanding the neurobiological factors underlying white matter changes associated with AN and invite further investigations examining associations between white matter properties and specific physiological, cognitive, social, or emotional functions affected in AN.

  3. Psychological and behavioural characteristics of females with anorexia nervosa in Singapore.

    Science.gov (United States)

    Tan, Evangeline S L; Hawkins, Russell M F

    2017-12-01

    This study aimed to compare a sample of females with anorexia nervosa in Singapore with international clinical and population samples from published data in terms of endorsement of risk factors related to anorexia nervosa, severity of eating pathology and levels of psychosocial impairment and to explore the nature of the relationships between the anorexia nervosa risk factors and adherence to Asian cultural values. Data from the Eating Disorder Inventory-3 (EDI-3), the Eating Attitudes Test (EAT-26), the Perceived Sociocultural Pressure Scale (PSPS), the Ideal Body Stereotype Scale (IBSS), the Eating Disorder Examination Questionnaire (EDE-Q), the Clinical Impairment Assessment Questionnaire, and the Asian American Values Scale-Multidimensional (AAVS-M) were collected from 41 female patients (13-31 years old) who presented for treatment of anorexia nervosa at the Singapore General Hospital. The profile and presentation of anorexia nervosa in Singapore was comparable to that observed in the Western clinical samples in terms of levels of endorsement of the risk factors for anorexia nervosa. No protective benefit of orientation to Asian culture was found. The observed pattern of general similarity of presentation between Western data and Singaporean data, together with the finding that no protective benefit of orientation to Asian culture was observed, suggests that it may be appropriate to directly apply evidence-based Western models of intervention to the treatment of anorexia nervosa in Singapore.

  4. How much should I eat? Estimation of meal portions in anorexia nervosa.

    Science.gov (United States)

    Milos, Gabriella; Kuenzli, Cornelia; Soelch, Chantal Martin; Schumacher, Sonja; Moergeli, Hanspeter; Mueller-Pfeiffer, Christoph

    2013-04-01

    Pathological concern regarding one's weight and weight gain is a crucial feature of anorexia nervosa. Consequently, anorexia nervosa patients often claim that they are uncertain regarding the amount of food they should eat. The present study investigated whether individuals with anorexia nervosa show an altered estimation of meal portion sizes and whether this estimation is modulated by an intent-to-eat instruction (where patients are asked to imagine having to eat the presented meal), meal type and meal portion size. Twenty-four women with anorexia nervosa and 27 healthy women estimated, using a visual analogue scale, the size of six different portions of three different meals, with and without intent-to-eat instructions. Subjects with anorexia nervosa estimated the size of small and medium meal portions (but not large meal servings) as being significantly larger, compared to estimates of healthy controls. The overestimation of small meal portions by anorexia nervosa subjects was significantly greater in the intent-to-eat, compared to general, condition. These findings suggest that disturbed perceptions associated with anorexia nervosa not only include interoceptive awareness (i.e., body weight and shape), but also extend to external disorder-related objects such as meal portion size. Specific therapeutic interventions, such as training regarding meal portion evaluation, could address these difficulties. Copyright © 2013. Published by Elsevier Ltd.

  5. Processo de Enfermagem para pacientes com Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Vanessa Pellegrino Toledo

    2011-02-01

    Full Text Available Relato de experiência da aplicação do Processo de Enfermagem a uma paciente portadora de Anorexia Nervosa, utilizando histórico, diagnósticos, intervenções e resultados de enfermagem. As intervenções foram fundamentadas nos diagnósticos de enfermagem: distúrbio da imagem corporal, nutrição desequilibrada menos que as necessidades corporais, ansiedade, baixa autoestima crônica, intolerância a atividade, controle ineficaz do regime terapêutico, risco de infecção, volume de líquidos deficiente e isolamento social. A partir da aplicação do Processo de Enfermagem, os resultados planejados foram alcançados, proporcionando melhor qualidade de vida, no período em que permaneceu internada. Os fatores psíquicos, neurológicos, endócrinos e imunológicos, peculiares na anorexia nervosa, propiciaram a elaboração de um Processo de Enfermagem, que contribuiu de maneira positiva para a complementação da reabilitação da saúde da mesma

  6. Cognitive behvioral psychotherapy of a severe anorexia nervosa case

    Directory of Open Access Journals (Sweden)

    Selcuk ASLAN

    2016-08-01

    Full Text Available Anorexia Nervosa is a chronic, severe psychiatric illness characterized with life threatening weight loss. Patients with eating disorder almost devote their lives to lose weight. In the course of disorder, patients hold irrational fears of becoming overweight and are committed to lose weight with/without engaging bulimic behaviors. The effectiveness of drug treatment and psychotherapy is scant. Therefore, in this paper, treatment process of a 28 y.o patient with anorexia nervosa whom hospitalized to inpatient unit with 33kg is presented to discuss the effectiveness CBT treatment. After two weeks of intense psychiatric care, 10 sessions of CBT is delivered in inpatient unit resulting with significant improvements in her weight control behavior. She completed 6-week inpatient treatment and followed by this, she completed her treatment process as an outpatient client. By the end of treatment, she reached 50kg and sustained her weight afterwards. The records revealed that she manages to cope with her fears of gaining weights and stopped using safety behaviors. Moreover, it is reported that her maintaining behaviors like excessive exercising habits, purging and restrictive dieting abated. Exposure intervention is combined with CBT treatment introduced to help her to first accommodate an imaginary acceptance to idea of gaining weight and tolerating to reach her healthy targeted weight. This followed by using exposure interventions as a preventative instrument to help her overcome her fears of gaining weights, during the 6 months followup she maintained the healthy weight. [JCBPR 2016; 5(2.000: 94-103

  7. Current treatment for anorexia nervosa: efficacy, safety, and adherence

    Directory of Open Access Journals (Sweden)

    Lindsay P Bodell

    2010-10-01

    Full Text Available Lindsay P Bodell, Pamela K KeelDepartment of Psychology, Florida State University, Tallahassee, FL, USAAbstract: Anorexia nervosa (AN is a serious psychiatric illness associated with significant medical and psychiatric morbidity, psychosocial impairment, increased risk of death, and chronicity. Given the severity of the disorder, the establishment of safe and effective treatments is necessary. Several treatments have been tried in AN, but few favorable results have emerged. This paper reviews randomized controlled trials in AN, and provides a synthesis of existing data regarding the efficacy, safety, and adherence associated with pharmacologic and psychological interventions. Randomized controlled trials for the treatment of AN published in peer-reviewed journals were identified by electronic and manual searches. Overall, pharmacotherapy has limited benefits in the treatment of AN, with some promising preliminary findings associated with olanzapine, an antipsychotic agent. No single psychological intervention has demonstrated clear superiority in treating adults with AN. In adolescents with AN, the evidence base is strongest for the use of family therapy over alternative individual psychotherapies. Results highlight challenges in both treating individuals with AN and in studying the effects of those treatments, and further emphasize the importance of continued efforts to develop novel interventions. Treatment trials currently underway and areas for future research are discussed.Keywords: anorexia nervosa, treatment, pharmacotherapy, psychotherapy, randomized controlled trials

  8. The socio-emotional processing stream in Anorexia Nervosa.

    Science.gov (United States)

    Oldershaw, A; Hambrook, D; Stahl, D; Tchanturia, K; Treasure, J; Schmidt, U

    2011-01-01

    The significance of socio-emotional factors in development and maintenance of Anorexia Nervosa (AN) has been noted, but the literature is poorly integrated without clear models guiding research or treatment. This systematic review retrieved experimental studies of social-cognitive or affective processing in AN and categorised them using Ochsner's "Social-Emotional Processing Stream." Ochsner's "Processing Stream", based on healthy data, comprises five constructs: (1) acquisition of and (2) recognition and response to social-affective stimuli, (3) low-level and (4) high-level mental state inference and (5) context-sensitive emotion regulation. Thirty-seven experimental studies in Anorexia Nervosa were identified, mapping on to four of the five constructs (not Construct 3). A meta-analysis of nine affect recognition studies was conducted. AN patients demonstrated impairments in each of the four domains with preliminary reports that some difficulties are trait-like, and others ameliorate following recovery. Socio-emotional data was integrated with previous reports of neural abnormalities to generate an AN specific model of socio-emotional processing. Additional research is required for further definition and to translate experimental findings into clinical practice. Copyright © 2010 Elsevier Ltd. All rights reserved.

  9. Childhood body mass index in adolescent-onset anorexia nervosa.

    Science.gov (United States)

    Berkowitz, Staci A; Witt, Ashley A; Gillberg, Christopher; Råstam, Maria; Wentz, Elisabet; Lowe, Michael R

    2016-11-01

    Although weight history is relevant in predicting eating disorder symptom severity, little is known about its role in the etiology of anorexia nervosa (AN). This study aimed to determine whether BMI or BMI trajectory differed between individuals who later developed adolescent-onset AN and a comparison group of HCs between school grades 1 through 6. This study was based on longitudinal data that identified 51 adolescents with AN and 51 matched HCs. Cases were identified through community screening in Sweden and included individuals born in 1969 through 1977. Measured weights and heights were retrieved and BMIs and weight trajectories of the AN and HC groups were compared using growth curve analysis. Main outcome measures included measured BMI and BMI trajectories from grades 1-6. Secondary outcomes examined included ponderal index at birth and maternal body weight. Individuals who later developed AN had higher BMIs than HCs between grades 1 and 6, by an average of 1.42 BMI-units. There was no difference in rate of weight gain between groups. Ponderal index at birth was higher for the AN as compared with HC group. Maternal weight did not differ significantly between groups. These findings, combined with those previously reported on the premorbid BMIs of those with bulimia nervosa, suggest that a predisposition toward elevated premorbid BMIs during childhood characterizes those who later develop anorexia or bulimia nervosa. These findings are consistent with a transdiagnostic perspective and suggest shared risk factors for AN and obesity. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1002-1009). © 2016 Wiley Periodicals, Inc.

  10. The Roy Adaptation Model: A Theoretical Framework for Nurses Providing Care to Individuals With Anorexia Nervosa.

    Science.gov (United States)

    Jennings, Karen M

    Using a nursing theoretical framework to understand, elucidate, and propose nursing research is fundamental to knowledge development. This article presents the Roy Adaptation Model as a theoretical framework to better understand individuals with anorexia nervosa during acute treatment, and the role of nursing assessments and interventions in the promotion of weight restoration. Nursing assessments and interventions situated within the Roy Adaptation Model take into consideration how weight restoration does not occur in isolation but rather reflects an adaptive process within external and internal environments, and has the potential for more holistic care.

  11. Perceived expressed emotion in anorexia nervosa, bulimia nervosa, and binge-eating disorder.

    Science.gov (United States)

    Di Paola, Fiammetta; Faravelli, Carlo; Ricca, Valdo

    2010-01-01

    The aim of this study was to verify the level of expressed emotion (EE) as perceived from patients with an eating disorder (ED). The Italian translation of the Level of Expressed Emotion Scale was administered to 63 female patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of anorexia nervosa, bulimia nervosa, and binge-eating disorder and 63 control subjects, according to a case-control procedure. Patients with ED showed higher level of perceived EE than controls, whereas no significant differences were observed when comparing the 3 patient subgroups. The level of perceived EE was found to be independent of age, person who has been most influential in the patient's life, amount of contacts, and duration of treatment. Different associations between eating disorder psychopathology and EE were found, suggesting a close relationship between the emotional response and tolerance of influential person and the dysfunctional attitudes regarding eating, weight, and body shape. Copyright 2010 Elsevier Inc. All rights reserved.

  12. Investigation of Oxytocin Secretion in Anorexia Nervosa and Bulimia Nervosa: Relationships to Temperament Personality Dimensions.

    Science.gov (United States)

    Monteleone, Alessio Maria; Scognamiglio, Pasquale; Volpe, Umberto; Di Maso, Virginia; Monteleone, Palmiero

    2016-01-01

    Published studies suggested an implication of oxytocin in some temperament characteristics of personality. Therefore, we measured oxytocin secretion in 23 women with anorexia nervosa (AN), 27 with bulimia nervosa (BN) and 19 healthy controls and explored the relationships between circulating oxytocin and patients' personality traits. Plasma oxytocin levels were significantly reduced in AN women but not in BN ones. In healthy women, the attachment subscale scores of the reward dependence temperament and the harm avoidance (HA) scores explained 82% of the variability in circulating oxytocin. In BN patients, plasma oxytocin resulted to be negatively correlated with HA, whereas no significant correlations emerged in AN patients. These findings confirm a dysregulation of oxytocin production in AN but not in BN and show, for the first time, a disruption of the associations between hormone levels and patients' temperament traits, which may have a role in certain deranged behaviours of eating disorder patients. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  13. Dysregulation of brain reward systems in eating disorders: neurochemical information from animal models of binge eating, bulimia nervosa, and anorexia nervosa.

    Science.gov (United States)

    Avena, Nicole M; Bocarsly, Miriam E

    2012-07-01

    Food intake is mediated, in part, through brain pathways for motivation and reinforcement. Dysregulation of these pathways may underlay some of the behaviors exhibited by patients with eating disorders. Research using animal models of eating disorders has greatly contributed to the detailed study of potential brain mechanisms that many underlie the causes or consequences of aberrant eating behaviors. This review focuses on neurochemical evidence of reward-related brain dysfunctions obtained through animal models of binge eating, bulimia nervosa, or anorexia nervosa. The findings suggest that alterations in dopamine (DA), acetylcholine (ACh) and opioid systems in reward-related brain areas occur in response to binge eating of palatable foods. Moreover, animal models of bulimia nervosa suggest that while bingeing on palatable food releases DA, purging attenuates the release of ACh that might otherwise signal satiety. Animal models of anorexia nervosa suggest that restricted access to food enhances the reinforcing effects of DA when the animal does eat. The activity-based anorexia model suggests alterations in mesolimbic DA and serotonin occur as a result of restricted eating coupled with excessive wheel running. These findings with animal models complement data obtained through neuroimaging and pharmacotherapy studies of clinical populations. Information on the neurochemical consequences of the behaviors associated with these eating disorders will be useful in understanding these complex disorders and may inform future therapeutic approaches, as discussed here. This article is part of a Special Issue entitled 'Central Control of Food Intake'. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. Dysregulation of Brain Reward Systems in Eating Disorders: Neurochemical Information from Animal Models of Binge Eating, Bulimia Nervosa, and Anorexia Nervosa

    Science.gov (United States)

    Avena, Nicole M.; Bocarsly, Miriam E.

    2012-01-01

    Food intake is mediated, in part, through brain pathways for motivation and reinforcement. Dysregulation of these pathways may underlay some of the behaviors exhibited by patients with eating disorders. Research using animal models of eating disorders has greatly contributed to the detailed study of potential brain mechanisms that many underlie the causes or consequences of aberrant eating behaviors. This review focuses on neurochemical evidence of reward-related brain dysfunctions obtained through animal models of binge eating, bulimia nervosa, or anorexia nervosa. The findings suggest that alterations in dopamine (DA), acetylcholine (ACh) and opioid systems in reward-related brain areas occur in response to binge eating of palatable foods. Moreover, animal models of bulimia nervosa suggest that while bingeing on palatable food releases DA, purging attenuates the release of ACh that might otherwise signal satiety. Animal models of anorexia nervosa suggest that restricted access to food enhances the reinforcing effects of DA when the animal does eat. The activity-based anorexia model suggests alterations in mesolimbic DA and serotonin occur as a result of starvation coupled with excessive wheel running. These findings with animal models complement data obtained through neuroimaging and pharmacotherapy studies of clinical populations. Finally, information on the neurochemical consequences of the behaviors associated with these eating disorders will be useful in understanding these complex disorders and may inform future therapeutic approaches, as discussed here. PMID:22138162

  15. Diurnal variation of the serum leptin concentration in patients with anorexia nervosa

    DEFF Research Database (Denmark)

    Stoving, R.K.; Vinten, Jørgen; Handberg, A.

    1998-01-01

    , however, this has been reported to be absent in normal weighted amenorrheic athletes. Anorexia nervosa is associated with multiple endocrine abnormalities. Hypothalamic amenorrhoea often precedes the weight loss and may persist after weight recovery. We hypothesized that leptin could be involved...... in the regulation of eating behaviour and gonadal function in anorexia nervosa. DESIGN: We measured the concentration of leptin in serum samples taken after an overnight fast in 18 female anorexia nervosa patients and 11 controls. To study diurnal variation, eight patients and 11 controls were hospitalized for 24 h...... and had a standardized diet at regular times. Seven blood samples were obtained at 4 h intervals from each subject. PATIENTS: The patients fulfilled the DSM-IV criteria for anorexia nervosa. The mean body mass index for the patients was 14.2 +/- 2.3 kg/m2 and for controls 20.3 +/- 1.7 kg/m2. RESULTS...

  16. Anorexia Nervosa Presented with Fever and Pancytopenia Due to Severe Constipation

    Directory of Open Access Journals (Sweden)

    Senay Akbay

    2014-06-01

    Full Text Available The prevalence of eating disorders is on the increase in adolescence and childhood. The peak age of onset occurs between 14 and 19 years. Anorexia nervosa is diagnosed approximately nine times more often in females than in males. Anorexia nervosa is a eating disorder that occurs mainly in female adolescents and young women. Eating disorders are associated with severe and sometimes life-threatening medical and psychiatric comorbidities. Hematological abnormalities are common in anorexia nervosa. But severe bone marrow supression has rarely been reported. To our knowledge, there is not any publication in the literature about bone marrow supression due to constipation.We reported here a 17 years old girl diagnosed as anorexia nervosa who was not wasted yet, presented with constipation and developed fever and pancytopenia.

  17. Heightened Olfactory Sensitivity in Young Females with Recent-Onset Anorexia Nervosa and Recovered Individuals

    DEFF Research Database (Denmark)

    Bentz, Mette; Guldberg, Johanne; Vangkilde, Signe

    2017-01-01

    INTRODUCTION: Olfaction may be related to food restriction and weight loss. However, reports regarding olfactory function in individuals with anorexia nervosa (AN) have been inconclusive. OBJECTIVE: Characterize olfactory sensitivity and identification in female adolescents and young adults...

  18. Intimate stimuli result in fronto-parietal activation changes in anorexia nervosa

    NARCIS (Netherlands)

    van Zutphen, L; Maier, S; Siep, N; Jacob, G A; Tüscher, O; van Elst, L Tebartz; Zeeck, A; Arntz, A; O'Connor, M-F; Stamm, H; Hudek, M; Joos, Andreas

    2018-01-01

    BACKGROUND: Intimacy is a key psychological problem in anorexia nervosa (AN). Empirical evidence, including neurobiological underpinnings, is however, scarce. OBJECTIVE: In this study, we evaluated various emotional stimuli including intimate stimuli experienced in patients with AN and non-patients,

  19. Mirtazapine in the treatment of adolescent anorexia nervosa. Case-control study

    Czech Academy of Sciences Publication Activity Database

    Hrdlička, M.; Beranová, I.; Zámečníková, R.; Urbánek, Tomáš

    2008-01-01

    Roč. 17, č. 3 (2008), s. 187-189 ISSN 1018-8827 Institutional research plan: CEZ:AV0Z70250504 Keywords : anorexia nervosa * treatment * antidepressants Subject RIV: AN - Psychology Impact factor: 1.769, year: 2008

  20. Anorexia nervosa complicated by diabetes mellitus: the case for permissive hyperglycemia.

    Science.gov (United States)

    Brown, Carrie; Mehler, Philip S

    2014-09-01

    The coexistence of Type 1 Diabetes Mellitus and anorexia nervosa results in an increased incidence of known diabetic complications such as retinopathy and nephropathy, presumably because blood glucose is difficult to control within the throes of comorbid anorexia nervosa. In addition, even when a diabetic patient with anorexia nervosa has committed to resolving his or her eating disorder, glucose control is again difficult and fraught with complexity and peril as will be highlighted in the following case report. Prudence dictates that strict glucose control is not indicated for the relatively short period of time that constitutes the early stage of refeeding in a patient with severe anorexia nervosa. Rather, "permissive hyperglycemia" may be the more optimal course to pursue, as a clinical strategy which is considerate of both the criticality of the refeeding treatment plan and of the long-term nature of the diabetic illness. © 2014 Wiley Periodicals, Inc.

  1. Dysfunctional metacognition and drive for thinness in typical and atypical anorexia nervosa.

    Science.gov (United States)

    Davenport, Emily; Rushford, Nola; Soon, Siew; McDermott, Cressida

    2015-01-01

    Anorexia nervosa is complex and difficult to treat. In cognitive therapies the focus has been on cognitive content rather than process. Process-oriented therapies may modify the higher level cognitive processes of metacognition, reported as dysfunctional in adult anorexia nervosa. Their association with clinical features of anorexia nervosa, however, is unclear. With reclassification of anorexia nervosa by DSM-5 into typical and atypical groups, comparability of metacognition and drive for thinness across groups and relationships within groups is also unclear. Main objectives were to determine whether metacognitive factors differ across typical and atypical anorexia nervosa and a non-clinical community sample, and to explore a process model by determining whether drive for thinness is concurrently predicted by metacognitive factors. Women receiving treatment for anorexia nervosa (n = 119) and non-clinical community participants (n = 100), aged between 18 and 46 years, completed the Eating Disorders Inventory (3(rd) Edition) and Metacognitions Questionnaire (Brief Version). Body Mass Index (BMI) of 18.5 kg/m(2) differentiated between typical (n = 75) and atypical (n = 44) anorexia nervosa. Multivariate analyses of variance and regression analyses were conducted. Metacognitive profiles were similar in both typical and atypical anorexia nervosa and confirmed as more dysfunctional than in the non-clinical group. Drive for thinness was concurrently predicted in the typical patients by the metacognitive factors, positive beliefs about worry, and need to control thoughts; in the atypical patients by negative beliefs about worry and, inversely, by cognitive self-consciousness, and in the non-clinical group by cognitive self-consciousness. Despite having a healthier weight, the atypical group was as severely affected by dysfunctional metacognitions and drive for thinness as the typical group. Because metacognition concurrently predicted drive for thinness

  2. Significant Locus and Metabolic Genetic Correlations Revealed in Genome-Wide Association Study of Anorexia Nervosa.

    Science.gov (United States)

    Duncan, Laramie; Yilmaz, Zeynep; Gaspar, Helena; Walters, Raymond; Goldstein, Jackie; Anttila, Verneri; Bulik-Sullivan, Brendan; Ripke, Stephan; Thornton, Laura; Hinney, Anke; Daly, Mark; Sullivan, Patrick F; Zeggini, Eleftheria; Breen, Gerome; Bulik, Cynthia M

    2017-09-01

    The authors conducted a genome-wide association study of anorexia nervosa and calculated genetic correlations with a series of psychiatric, educational, and metabolic phenotypes. Following uniform quality control and imputation procedures using the 1000 Genomes Project (phase 3) in 12 case-control cohorts comprising 3,495 anorexia nervosa cases and 10,982 controls, the authors performed standard association analysis followed by a meta-analysis across cohorts. Linkage disequilibrium score regression was used to calculate genome-wide common variant heritability (single-nucleotide polymorphism [SNP]-based heritability [h 2 SNP ]), partitioned heritability, and genetic correlations (r g ) between anorexia nervosa and 159 other phenotypes. Results were obtained for 10,641,224 SNPs and insertion-deletion variants with minor allele frequencies >1% and imputation quality scores >0.6. The h 2 SNP of anorexia nervosa was 0.20 (SE=0.02), suggesting that a substantial fraction of the twin-based heritability arises from common genetic variation. The authors identified one genome-wide significant locus on chromosome 12 (rs4622308) in a region harboring a previously reported type 1 diabetes and autoimmune disorder locus. Significant positive genetic correlations were observed between anorexia nervosa and schizophrenia, neuroticism, educational attainment, and high-density lipoprotein cholesterol, and significant negative genetic correlations were observed between anorexia nervosa and body mass index, insulin, glucose, and lipid phenotypes. Anorexia nervosa is a complex heritable phenotype for which this study has uncovered the first genome-wide significant locus. Anorexia nervosa also has large and significant genetic correlations with both psychiatric phenotypes and metabolic traits. The study results encourage a reconceptualization of this frequently lethal disorder as one with both psychiatric and metabolic etiology.

  3. Severe and enduring Anorexia Nervosa in the England and Wales Court of Protection.

    OpenAIRE

    Cave, Emma; Tan, Jacinta

    2017-01-01

    This article explores legal issues relating to the continuation of in-patient treatment for some patients with severe Anorexia Nervosa, in circumstances where there are doubts as to whether such treatment would be effective. In five recent cases, the Court of Protection in England and Wales has been asked to consider the capacity and best interests of patients with severe and enduring Anorexia Nervosa. Drawing on international comparisons, this article outlines clinical uncertainties over pro...

  4. Androgens in Women with Anorexia Nervosa and Normal-Weight Women with Hypothalamic Amenorrhea

    Science.gov (United States)

    Miller, K. K.; Lawson, E. A.; Mathur, V.; Wexler, T. L.; Meenaghan, E.; Misra, M.; Herzog, D. B.; Klibanski, A.

    2011-01-01

    Context Anorexia nervosa and normal-weight hypothalamic amenorrhea are characterized by hypogonadism and hypercortisolemia. However, it is not known whether these endocrine abnormalities result in reductions in adrenal and/or ovarian androgens or androgen precursors in such women, nor is it known whether relative androgen deficiency contributes to abnormalities in bone density and body composition in this population. Objective Our objective was to determine whether endogenous androgen and dehydroepiandrosterone sulfate (DHEAS) levels: 1) are reduced in women with anorexia nervosa and normal-weight hypothalamic amenorrhea, 2) are reduced further by oral contraceptives in women with anorexia nervosa, and 3) are predictors of weight, body composition, or bone density in such women. Design and Setting We conducted a cross-sectional study at a general clinical research center. Study Participants A total of 217 women were studied: 137 women with anorexia nervosa not receiving oral contraceptives, 32 women with anorexia nervosa receiving oral contraceptives, 21 normal-weight women with hypothalamic amenorrhea, and 27 healthy eumenorrheic controls. Main Outcome Measures Testosterone, free testosterone, DHEAS, bone density, fat-free mass, and fat mass were assessed. Results Endogenous total and free testosterone, but not DHEAS, were lower in women with anorexia nervosa than in controls. More marked reductions in both free testosterone and DHEAS were observed in women with anorexia nervosa receiving oral contraceptives. In contrast, normal-weight women with hypothalamic amenorrhea had normal androgen and DHEAS levels. Lower free testosterone, total testosterone, and DHEAS levels predicted lower bone density at most skeletal sites measured, and free testosterone was positively associated with fat-free mass. Conclusions Androgen levels are low, appear to be even further reduced by oral contraceptive use, and are predictors of bone density and fat-free mass in women with

  5. Low Birth Weight in the Offspring of Women With Anorexia Nervosa

    OpenAIRE

    Solmi, Francesca; Sallis, Hannah; Stahl, Daniel; Treasure, Janet; Micali, Nadia

    2013-01-01

    A growing body of literature has investigated the association between maternal anorexia nervosa and pregnancy outcomes. Infant low birth weight is associated with a number of neurodevelopmental and physical sequelae; however, consistent results on its association with maternal anorexia nervosa are scant. Therefore, a systematic review and meta-analysis of the existing literature were undertaken. PubMed, Embase, and PsychInfo were searched for studies comparing the mean birth weight of babies ...

  6. Interacting Neural Processes of Feeding, Hyperactivity, Stress, Reward, and the Utility of the Activity-Based Anorexia Model of Anorexia Nervosa.

    Science.gov (United States)

    Ross, Rachel A; Mandelblat-Cerf, Yael; Verstegen, Anne M J

    Anorexia nervosa (AN) is a psychiatric illness with minimal effective treatments and a very high rate of mortality. Understanding the neurobiological underpinnings of the disease is imperative for improving outcomes and can be aided by the study of animal models. The activity-based anorexia rodent model (ABA) is the current best parallel for the study of AN. This review describes the basic neurobiology of feeding and hyperactivity seen in both ABA and AN, and compiles the research on the role that stress-response and reward pathways play in modulating the homeostatic drive to eat and to expend energy, which become dysfunctional in ABA and AN.

  7. Process evaluation of the maudsley model for treatment of adults with anorexia nervosa trial. Part II: Patient experiences of two psychological therapies for treatment of anorexia nervosa.

    Science.gov (United States)

    Lose, Anna; Davies, Charlotte; Renwick, Beth; Kenyon, Martha; Treasure, Janet; Schmidt, Ulrike

    2014-03-01

    This study is the second part of a process evaluation, embedded in the MOSAIC study, a large randomised controlled trial comparing two different psychological therapies, the Maudsley Model for Treatment of Adults with Anorexia Nervosa (MANTRA) and Specialist Supportive Clinical Management (SSCM). The study adopted a qualitative approach to examine patient experiences of the two treatments. Seventeen semi-structured interviews were conducted with Anorexia Nervosa and Eating Disorder Not Otherwise Specified-Anorexia Nervosa type patients, and transcripts were analysed thematically. Patient responses yielded five main themes: positive and helpful aspects, beneficial outcomes, less helpful aspects, possible improvements to the treatments, and the therapeutic and external environment. The findings show clear differences and some overlaps between patients' views on MANTRA and SSCM. Both therapies were experienced by patients as credible and largely helpful, albeit in different ways. These results are in agreement with those of therapists' views on these treatments. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

  8. Autism Spectrum Disorder in Anorexia Nervosa: An Updated Literature Review.

    Science.gov (United States)

    Westwood, Heather; Tchanturia, Kate

    2017-07-01

    There is growing interest in the relationship between anorexia nervosa (AN) and autism spectrum disorder (ASD). This review aimed to synthesise the most recent research on this topic to identify gaps in current knowledge, directions for future research and reflect on implications for treatment. Eight studies assessing the presence of ASD in AN were identified in the literature along with three studies examining the impact of symptoms of ASD on treatment outcome. Research with young people and using parental-report measures suggest lower rates of co-morbidity than previous adult studies. The wide range of diagnostic tools, methodologies and populations studied make it difficult to determine the prevalence of ASD in AN. Despite this, studies consistently report over-representation of symptoms of ASD in AN. Co-morbid AN and ASD may require more intensive treatment or specifically tailored interventions. Future longitudinal research and female-specific diagnostic tools would help elucidate the relationship between these two disorders.

  9. Attachment Insecurity Predicts Punishment Sensitivity in Anorexia Nervosa.

    Science.gov (United States)

    Keating, Charlotte; Castle, David J; Newton, Richard; Huang, Chia; Rossell, Susan L

    2016-10-01

    Individuals with anorexia nervosa (AN) experience insecure attachment. We investigated whether insecure attachment is associated with punishment and reward sensitivity in women with AN. Women with AN (n = 24) and comparison women (n = 26) (CW) completed The Eating Disorder Examination Questionnaire, Depression Anxiety Stress Scale, The Attachment Style Questionnaire, and Sensitivity to Punishment/Sensitivity to Reward Questionnaire. Participants with AN returned higher ratings for insecure attachment (anxious and avoidant) experiences and greater sensitivity to punishment (p = 0.001) than CW. In AN, sensitivity to punishment was positively correlated with anxious attachment and negative emotionality but not eating disorder symptoms. Regression analysis revealed that anxious attachment independently predicted punishment sensitivity in AN. Anxious attachment experiences are related to punishment sensitivity in AN, independent of negative emotionality and eating disorder symptoms. Results support ongoing investigation of the contribution of attachment experiences in treatment and recovery.

  10. Purtscher-Like Retinopathy Associated with Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Bugra Karasu

    2016-01-01

    Full Text Available A 21-year-old girl presented with acute painless vision loss in her right eye. There was no remarkable ocular history and she had a history of anorexia nervosa. At presentation best-corrected visual acuities were counting fingers from 2 meters and 20/20, in the right and left eyes, respectively. Slit lamp examination result was normal. Fundus examination revealed multiple cotton wool spots and intraretinal hemorrhages surrounding the optic disc and macula in the right eye. Fluorescein angiography showed capillary filling defect and leakage from optic disc in the late phase of the angiogram. One week later best-corrected visual acuities remained the same in both eyes with similar fundus appearance. One month after initial presentation visual acuity was 20/20 in both eyes with no abnormality in fundus appearance.

  11. Effects of Anorexia Nervosa on the Endocrine System.

    Science.gov (United States)

    Baskaran, Charumathi; Misra, Madhusmita; Klibanski, Anne

    2017-03-01

    Anorexia nervosa (AN) is characterized by severe undernutrition associated with alterations in multiple endocrine axes, which are primarily adaptive to the state of caloric deprivation. Hormonal changes include growth hormone (GH) resistance with low insulin like growth factor-1 (IGF-1) levels, hypothalamic hypogonadism, relative hypercortisolemia and changes in appetite regulating hormones, including leptin, ghrelin, and peptide YY. These alterations contribute to abnormalities in bone metabolism leading to low bone mass, impaired bone microarchitecture, and increased risk for fracture, and may also negatively impact cognition, emotions and mood. The best strategy to improve all biologic outcomes is weight and menstrual recovery. Physiological estrogen replacement improves bone accrual rates and measures of trait anxiety in adolescents with AN. Other therapies including testosterone and IGF-1 replacement, and use of DHEA with oral estrogen-progesterone combination pills, bisphosphonates and teriparatide have also been studied to improve bone outcomes. Copyright© of YS Medical Media ltd.

  12. Cognitive Behavioral Therapy for Anorexia Nervosa: An Update.

    Science.gov (United States)

    Dalle Grave, Riccardo; El Ghoch, Marwan; Sartirana, Massimiliano; Calugi, Simona

    2016-01-01

    Cognitive behavioral therapy (CBT) for anorexia nervosa (AN), based on Beck's cognitive theory, was developed in a "generic" form in the early eighties. In recent years, however, improved knowledge of the mechanisms involved in maintaining eating disorder psychopathology has led to the development of a "specific" form of CBT, termed CBT-E (E = enhanced), designed to treat all forms of eating disorders, including AN, from outpatient to inpatient settings. Although more studies are required to assess the relative effectiveness of CBT-E with respect to other available treatments, the data indicate that in outpatient settings it is both viable and promising for adults and adolescents with AN. Encouraging results are also emerging from inpatient CBT-E, particularly in adolescents, and clinical services offering CBT-E at different levels of care are now offered in several countries around the world. However, CBT-E requires dissemination in order to become widely available to patients.

  13. Anorexia nervosa and gender dysphoria in two adolescents.

    Science.gov (United States)

    Couturier, Jennifer; Pindiprolu, Bharadwaj; Findlay, Sheri; Johnson, Natasha

    2015-01-01

    Little has been published about the co-occurrence of gender dysphoria (GD) and eating disorders (ED) in adults, with no cases described in the adolescent population. The emphasis on body shape in both conditions suggests that there may be some overlap in symptomatology. We report two adolescent cases initially diagnosed with anorexia nervosa who later met criteria for GD. The drive for thinness for the 16-year-old male was associated with a wish to achieve a feminine physique whereas there was an emphasis for stunted breast growth and a desire for muscularity in the 13-year-old female. Complexities in presentation, evolution of symptoms over time, and the treatment of the two cases are discussed. Clinicians should inquire about sexual issues in the presentation of ED and should monitor for symptoms of GD, not only at initial presentation, but throughout treatment, especially as weight gain progresses. © 2014 Wiley Periodicals, Inc.

  14. Cognitive Profile of Children and Adolescents with Anorexia Nervosa

    DEFF Research Database (Denmark)

    Kjaersdam Telléus, Gry; Jepsen, Jens Richardt; Bentz, Mette

    2015-01-01

    OBJECTIVE: Few studies of cognitive functioning in children and adolescents with anorexia nervosa (AN) have been conducted. The aim of this study was to examine the neurocognitive and intelligence profile of this clinical group. METHOD: The study was a matched case-control (N = 188), multi......-centre study including children and adolescents with AN (N = 94) and healthy control participants (N = 94). RESULTS: The results suggest that Full Scale Intelligence Quotient (Wechsler Intelligence Scale for Children-III/Wechsler Adult Intelligence Scale-III) in this patient group is close to the normal...... and Trail Making Test B) was found. CONCLUSIONS: Inefficiency in nonverbal intelligence functions and in specific cognitive functions was found in this study of children and adolescents with AN. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd....

  15. Anorexia Nervosa and Refeeding Syndrome. A Case Report

    Directory of Open Access Journals (Sweden)

    Kohji Azumagawa

    2007-01-01

    Full Text Available This is a case story of a 14-year-old girl with severe anorexia nervosa (AN (158 cm, 28 kg, –44.1% ideal body mass index, admitted with purpura, edema, and general fatigue. We treated her carefully and paid particular attention to prevent development of refeeding syndrome (RS, and her body weight increased satisfactorily. However, RS (edema, hypoalbuminemia, and heart failure occurred despite careful treatment. We used albumin and diuretics for treatment of RS, but severe liver damage resulted. RS was aggravated by the medical treatment. More attention should have been paid to her weight gain and medical treatment should have been initiated more slowly to prevent dramatic changes in the patient's fluid and electrolyte status.

  16. An Adolescent Boy with Comorbid Anorexia Nervosa and Hashimoto Thyroiditis.

    Science.gov (United States)

    Pehlivantürk Kızılkan, Melis; Kanbur, Nuray; Akgül, Sinem; Alikaşifoğlu, Ayfer

    2016-03-05

    Low triiodothyronine syndrome is a physiological adaptation encountered in anorexia nervosa (AN) and generally improves with sufficient weight gain. However, when a primary thyroid pathology accompanies AN, both the evaluation of thyroid hormone levels and the management of the co-morbid disease become more challenging. Hashimoto thyroiditis could complicate the management of AN by causing hyper- or hypothyroidism. AN could also negatively affect the treatment of Hashimoto thyroiditis by altering body weight and metabolic rate, as well as by causing drug non-compliance. We present the case of a 15-year-old boy with comorbid AN restrictive sub-type and Hashimoto thyroiditis. In this case report, we aimed to draw attention to the challenges that could be encountered in the diagnosis, treatment, and follow-up of patients with AN when accompanied by Hashimoto thyroiditis.

  17. Practice guidelines for acupuncturists using acupuncture as an adjunctive treatment for anorexia nervosa.

    Science.gov (United States)

    Fogarty, Sarah; Ramjan, Lucie Michelle

    2015-02-01

    Anorexia nervosa is a potentially life-threatening eating disorder where people intentionally refuse to eat sufficient amounts to maintain a healthy body-weight for fear of becoming fat. The intense preoccupation with restriction of food and control of body weight makes this one of the most complex and confusing conditions for practitioners to treat. While no single treatment has been found to be superior to another in the treatment of anorexia nervosa, general practice guidelines are available to guide mainstream treatment, however there are no guidelines for practitioners of complementary therapies. Complementary therapies such as acupuncture show promise as an adjunctive therapy in improving co-morbidities such as depression and anxiety levels among people with anorexia nervosa, by strengthening mind, body and overall well-being. The aim of this guideline is to assist and support acupuncture practitioners to deliver effective and safe adjunctive acupuncture treatments to people with anorexia nervosa, by providing a practice guideline that is underpinned by an ethical and evidence-based framework. The use of complementary therapies and specifically acupuncture in the treatment of anorexia nervosa may provide important adjunctive care to allow a comprehensive treatment approach that potentially improves quality of life, reduces anxiety and instils hope for recovery. It is hoped that acupuncture practitioners treating patients with anorexia nervosa will refer to these guidelines and apply the guidance (as deemed appropriate). Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Pneumococcal sepsis associated with adrenal apoplexy in a young woman with anorexia nervosa

    Directory of Open Access Journals (Sweden)

    Nicola Maria Vitola

    2013-05-01

    Full Text Available BACKGROUND A crude rate of mortality of 5% has been quoted for anorexia nervosa in recent studies. Nowadays the mechanism of death is unclear and various authors recommend that any anorexia nervosa death be reported and that, where possible, an autopsy be performed. METHODS In this work we present a case of sudden death in anorexia nervosa with unexpected autopsy findings. A 21-years-old woman with long-standing anorexia nervosa, severely underweight with a body mass index of 14.47 kg/m2, has been taken to the Emergency Department in very critical conditions. Despite the attempts of resuscitation, she died shortly afterwards. Therefore an autopsy has been requested in order to clarify the causes of death. RESULTS The clinical picture, laboratory parameters, histology and microbiological investigations were consistent with pneumococcal sepsis associated adrenal apoplexy. CONCLUSIONS The cause of death in anorexia nervosa cannot reliably be established from antemortem clinical features. All anorexia nervosa deaths should be reported together with description of necropsy. This may lead to advances in the knowledge and treatment practices.

  19. Defining "significant weight loss" in atypical anorexia nervosa.

    Science.gov (United States)

    Forney, K Jean; Brown, Tiffany A; Holland-Carter, Lauren A; Kennedy, Grace A; Keel, Pamela K

    2017-08-01

    Atypical anorexia nervosa (AAN) is defined by the symptoms of anorexia nervosa in the presence of "significant weight loss" in individuals who are not underweight. Description of current weight in AAN has been limited, significant weight loss has not been defined, and the distinction between having AAN versus having weight suppression has not been examined. Secondary analyses were conducted with data from an epidemiological study of women (n = 1,640) and men (n = 794). Three definitions of significant weight loss (5, 10, and 15%) for AAN were tested in comparisons with controls and a DSM-5 eating disorder group (DSM-5 ED) on measures of eating pathology and clinical significance using ANCOVA and logistic regression, controlling for age and body mass index. Secondary analyses compared AAN to a weight suppressed group (WS-only) and a cognitive concerns group (COG-only). Across weight loss thresholds, ≥25% of adults with AAN were currently overweight/obese. At the 5% and 10% definitions, AAN was associated with elevated eating pathology and distress relative to controls, WS-only, and COG-only in women and men. Women with AAN endorsed less eating pathology and distress than DSM-5 ED at some weight loss definitions, whereas men with AAN did not differ from DSM-5 ED in eating pathology or distress. Results support that even a 5% weight loss, combined with cognitive concerns, may produce a group with a clinically significant eating disorder. AAN was observed in both healthy weight and overweight/obese adults, highlighting the importance of screening for restrictive eating disorders at all weights. © 2017 Wiley Periodicals, Inc.

  20. Selective cognitive empathy deficit in adolescents with restrictive anorexia nervosa

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    Calderoni S

    2013-10-01

    Full Text Available Sara Calderoni,1 Pamela Fantozzi,1 Sandra Maestro,1 Elena Brunori,1 Antonio Narzisi,1 Giulia Balboni,2 Filippo Muratori1,31Department of Child Neurology and Psychiatry, IRCCS Stella Maris Foundation, 2Department of Surgery, Medical, Molecular and Critical Area Pathology, University of Pisa, 3Department of Developmental Medicine, University of Pisa, Pisa, ItalyBackground: A growing, but conflicting body of literature suggests altered empathic abilities in subjects with anorexia nervosa-restricting type (AN-R. This study aims to characterize the cognitive and affective empathic profiles of adolescents with purely AN-R.Methods: As part of a standardized clinical and research protocol, the Interpersonal Reactivity Index (IRI, a valid and reliable self-reported instrument to measure empathy, was administered to 32 female adolescents with AN-R and in 41 healthy controls (HC comparisons, matched for age and gender. Correlational analyses were performed to evaluate the links between empathy scores and psychopathological measures.Results: Patients scored significantly lower than HC on cognitive empathy (CE, while they did not differ from controls on affective empathy (AE. The deficit in CE was not related to either disease severity nor was it related to associated psychopathology.Conclusion: These results, albeit preliminary, suggest that a dysfunctional pattern of CE capacity may be a stable trait of AN-R that should be taken into account not only for the clinical management, but also in preventive and therapeutic intervention.Keywords: anorexia nervosa-restricting type, cognitive empathy, affective empathy, female adolescents, Interpersonal Reactivity Index

  1. Dialectical Behavior Therapy of Anorexia and Bulimia Nervosa among Adolescents: A Case Series

    Science.gov (United States)

    Salbach-Andrae, Harriet; Bohnekamp, Inga; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Miller, Alec L.

    2008-01-01

    The aim of this study was to describe a case series of adolescents (mean age = 16.5 years, SD = 1.0) with anorexia nervosa (AN) and bulimia nervosa (BN) who received dialectical behavior therapy (DBT). Twelve outpatients with AN and BN took part in 25 weeks of twice weekly therapy consisting of individual therapy and a skills training group.…

  2. Unusual presentation of uncommon disease: anorexia nervosa presenting as wernicke-korsakoff syndrome-a case report from southeast Asia.

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    Mushtaq, Raheel; Shoib, Sheikh; Shah, Tabindah; Bhat, Mudasir; Singh, Randhir; Mushtaq, Sahil

    2014-01-01

    Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome.

  3. Unusual Presentation of Uncommon Disease: Anorexia Nervosa Presenting as Wernicke-Korsakoff Syndrome—A Case Report from Southeast Asia

    Science.gov (United States)

    Mushtaq, Raheel; Shah, Tabindah; Bhat, Mudasir; Mushtaq, Sahil

    2014-01-01

    Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome. PMID:24963430

  4. Unusual Presentation of Uncommon Disease: Anorexia Nervosa Presenting as Wernicke-Korsakoff Syndrome—A Case Report from Southeast Asia

    Directory of Open Access Journals (Sweden)

    Raheel Mushtaq

    2014-01-01

    Full Text Available Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome.

  5. Anorexia nervosa, depression and suicidal thoughts among Chinese adolescents: a national school-based cross-sectional study

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    Lian, Qiguo; Zuo, Xiayun; Mao, Yanyan; Luo, Shan; Zhang, Shucheng; Tu, Xiaowen; Lou, Chaohua; Zhou, Weijin

    2017-01-01

    Background Although there is much literature on adolescent suicide, combined effects of depression and anorexia nervosa on suicide were rarely investigated. The aims of this study are to examine the association between anorexia nervosa and suicidal thoughts and explore the interaction between anorexia nervosa and depression. Methods This is a cross-sectional study, in the study, a sample of 8,746 Chinese adolescents was selected by multistage stratified method in 2012/2013 from 20 middle scho...

  6. Community recognition and beliefs about anorexia nervosa and its treatment.

    Science.gov (United States)

    Darby, Anita M; Hay, Phillipa J; Mond, Jonathan M; Quirk, Frances

    2012-01-01

    Mental Health Literacy (MHL), namely recognition, and beliefs about treatment concerning Anorexia Nervosa (AN) were examined in a community sample of male and female (n = 983) aged 15-94 years. A vignette describing a women suffering from the symptoms of AN was presented, followed by a respondent-based structured interview concerning recognition of the problem and treatment beliefs. The majority of participants could identify the problem as that of an eating disorder, although only 16.1% could specifically identify it as AN. Many also believed the problem was primarily one of low self-esteem (32.5%). General practitioners and psychiatrists or psychologists were considered the most helpful treatment providers, while obtaining information about the problem and available services, followed by family therapy, were considered the most helpful treatments. Less than one-third of participants believed complete recovery was possible. Better AN MHL was found in younger, higher educated, and metropolitan domiciled females. This study offers encouraging results in regard to AN MHL. In particular, there was moderate regard for the use of mental health specialists in the treatment of the disorder. However, there appears to be a misconception that AN is largely the manifestation of low self-esteem and confusion concerning the distinction between AN and bulimia nervosa. AN MHL was poorer in males and those with higher social and health disadvantage. Copyright © 2010 Wiley Periodicals, Inc.

  7. [Choking phobia in childhood: a differential diagnosis with anorexia nervosa].

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    Bailly, D; de Chouly de Lenclave, M B; Dhaussy, S; Baert, F; Turck, D

    2003-04-01

    Choking phobia has been rarely described in the literature and its prevalence has not yet been determined. Because of its clinical picture (female predominance, avoidance or refusal of certain foodstuffs, secondary weight loss, associated obsessive-compulsive symptoms), it is often misdiagnosed as anorexia nervosa. The authors describe the case of an 11-year-old girl, hospitalised for anorexia, who actually had choking phobia. Following a long history of anxiety disorders (including separation anxiety, social phobia, obsessive-compulsive disorder), the choking phobia had been triggered by a traumatic choking episode occurred in her grandfather. The disorder was successfully treated by cognitive-behavioural techniques associated with an antidepressant therapy. This typical case questions the relationships between choking phobia and the other anxiety disorders of childhood and adolescence. According to data from the literature, the authors conclude that choking phobia may be regarded as a non developmental specific phobia, whose occurrence is facilitated by the presence of pre-existing anxiety disorders. The disorder is usually improved by cognitive-behavioural treatment.

  8. The imaginative use of religious symbols in subjective experiences of anorexia nervosa.

    Science.gov (United States)

    Banks, C G

    1997-04-01

    Clinicians working with contemporary women with anorexia nervosa have commented on the ascetic component in anorexia, meaning their self-denial, heightened morality, opposition between body and spirit, asexuality, and denial of bodily death (Mogul, 1980; Palazzoli, 1978; Rampling, 1985; Sabom, 1985; Turner, 1984). While these clinicians have commented on the asceticism in contemporary anorexia nervosa, they have little to say about the role of culture in subjective experiences of this asceticism. As we have seen, Jane and Margaret used notions of asceticism about food and the body that are a part of their religious beliefs to create a personal meaning system through which they expressed their self-starvation. These cases, while supporting clinical studies that point to an ascetic component in modern anorexia, go further to suggest that in some cases, this asceticism may be encoded in religion. Religious anorectics like Jane and Margaret challenge models of anorexia nervosa that understand the condition exclusively in terms of cultural foci on "dieting" and secular ideals of beauty and bodily thinness for women (Bemporad, Hoffman, & Herzog, 1989; Chernin, 1985; Garner et al., 1980; Orbach, 1986; Rost, Newhaus, & Florian, 1982). They also suggest a continuing persistence into the twentieth century of an association between religiosity and self-starvation noted by historians during the early Christian, medieval, and late-Victorian periods in the West (Bell, 1985; Brown, 1988; Brumberg, 1985, 1988; Bynum, 1987). The above discussion points to the new directions in psychological anthropology which challenge a strict and opposing dichotomy between the conscious and unconscious, between culture (seen as "public") and the individual mind (seen as "private" and idiosyncratic). Obeyesekere's concept of "the work of culture," (Obeyesekere, 1990) and Stephen's concept of the "autonomous imagination" are especially useful in understanding how persons like Jane and Margaret use

  9. Massa óssea em pacientes com anorexia nervosa

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    Santos Evaldo dos

    2004-01-01

    Full Text Available OBJETIVO: avaliar a ingestão diária de cálcio e estabelecer sua correlação com a densidade óssea de pacientes com anorexia nervos. PACIENTES E MÉTODOS: quatorze mulheres com anorexia nervosa registraram, em diário alimentar padronizado, sua ingestão em 24 horas e foram submetidas ao exame de densitometria óssea. A análise estatística foi feita pelos testes do c² e correlação de Pearson, adotando-se como significância estatística p<0,05. RESULTADOS: a média da densidade óssea na coluna lombar foi de 0,95 ± 0,15 e no colo do fêmur foi de 0,88 ± 0,26. Houve correlação significativa entre o tempo de amenorréia e a perda de massa óssea, tanto na coluna lombar (r=-0,65; p=0,01 como no fêmur (r=-0,71; (p=0,0068. Com exceção de uma paciente, todas apresentavam ingestão de cálcio inferior ao recomendado pelo RDA, com média de 554,5 mg/dia (variando de 120 a 840 mg/dia. Observou-se que 64% das pacientes apresentavam algum grau de perda de massa óssea (osteopenia ou osteoporose na coluna e 57% no fêmur. Das seis pacientes com déficit na ingestão de cálcio inferior a 60%, nenhuma apresentou osteoporose, ao passo que das oito pacientes com déficit superior a 60% na ingestão de cálcio, três tinham osteoporose. CONCLUSÃO: Pacientes com anorexia nervosa têm baixa ingestão de cálcio e perda significativa de massa óssea, que estão diretamente relacionadas entre si. A baixa densidade óssea está, também, correlacionada com o tempo de amenorréia.

  10. Sensory modulation disorder symptoms in anorexia nervosa and bulimia nervosa: A pilot study.

    Science.gov (United States)

    Brand-Gothelf, Ayelet; Parush, Shula; Eitan, Yehudith; Admoni, Shai; Gur, Eitan; Stein, Daniel

    2016-01-01

    Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) may exhibit reduced ability to modulate sensory, physiological, and affective responses. The aim of the present study is to assess sensory modulation disorder (SMD) symptoms in patients with AN and BN. We assessed female adolescent and young adult inpatients with restrictive type anorexia nervosa (AN-R; n = 20) and BN (n = 20) evaluated in the acute stage of their illness, and 27 female controls. Another group of 20 inpatients with AN-R was assessed on admission and discharge, upon achieving their required weight. Participants completed standardized questionnaires assessing the severity of their eating disorder (ED) and the sensory responsiveness questionnaire (SRQ). Inpatients with AN-R demonstrated elevated overall sensory over-responsiveness as well as elevated scores on the taste/gustatory, vestibular/kinesthetic and somatosensory/tactile SRQ modalities compared with patients with BN and controls. Significant correlations between the severity of sensory over-responsiveness and ED-related symptomatology were found in acutely-ill patients with AN-R and to a lesser extent, following weight restoration. Elevated sensory over-responsiveness was retained in weight-restored inpatients with AN-R. Inpatients with BN demonstrated greater sensory under-responsiveness in the intensity subscale of the SRQ, but not in the frequency and combined SRQ dimensions. Female inpatients with AN-R exhibited sensory over-responsiveness both in the acute stage of their illness and following weight restoration, suggesting that sensory over-responsiveness may represent a trait related to the illness itself above and beyond the influence of malnutrition. The finding for sensory under-responsiveness in BN is less consistent. © 2015 Wiley Periodicals, Inc.

  11. Clinical, psychopathological and personality correlates of interoceptive awareness in anorexia nervosa, bulimia nervosa and obesity.

    Science.gov (United States)

    Fassino, Secondo; Pierò, Andrea; Gramaglia, Carla; Abbate-Daga, Giovanni

    2004-01-01

    To determine the levels of interoceptive awareness (IA), which measures the ability of an individual to discriminate between sensations and feelings, and between the sensations of hunger and satiety, in eating disorder patients and to identify the clinical, psychopathological and personal variables correlated with IA. Sixty-one restrictor anorectics, 61 binge-purging anorectics, 104 purging bulimics, 49 obese subjects with binge eating disorder (BED) and 47 obese subjects without BED were compared. They were assessed with the Eating Disorder Inventory-2, the Temperament and Character Inventory, and the Beck Depression Inventory, and their clinical and sociodemographic features were recorded. In all patients, the levels of IA were higher than the 'normal' ones; in bulimia nervosa, they were higher than in anorexia nervosa and obesity. Similar personal features and eating attitudes are shared by patients with bulimia nervosa and BED. In the total sample, the following variables independently correlate with IA: the Beck Depression Inventory, self- directedness and persistence. The importance of an altered IA in eating disorders is supported. Both depression and a perfectionist and poorly self-directive personality can lead to greater difficulties in discriminating hunger and satiety. Copyright 2004 S. Karger AG, Basel

  12. An Adolescent Case of Citrin Deficiency With Severe Anorexia Mimicking Anorexia Nervosa.

    Science.gov (United States)

    Takeuchi, Satsuki; Yazaki, Masahide; Yamada, Shinji; Fukuyama, Tetsuhiro; Inui, Akio; Iwasaki, Yasushi; Ikeda, Shu-ichi

    2015-08-01

    We report a 12-year-old female citrin-deficient patient presenting with severe anorexia and body weight loss, mimicking the restricting type of anorexia nervosa (AN). She showed normal development until age 10 years when she started to play volleyball at school. She then became gradually anorexic, and her growth was stunted. At age 12, she was admitted to hospital because of severe anorexia and thinness. She was first thought to have AN, and drip infusion of glucose solution and high-calorie drinks were given, but her condition deteriorated further. She had a history of neonatal hepatitis and was therefore suspected to have citrin deficiency (CD). Genetic analysis of SLC25A13 revealed that she was compound heterozygous for 851del4 and IVS16ins3kb, and a diagnosis of CD was made. A low-carbohydrate diet with oral intake of arginine and ursodeoxycholic acid was started, and her condition gradually improved. The clinical features in our patient were similar to those of AN, and therefore AN may also be an important clinical sign in adolescent patients with CD. Copyright © 2015 by the American Academy of Pediatrics.

  13. How adolescents with anorexia nervosa and their parents perceive family functioning?

    Science.gov (United States)

    Laghi, Fiorenzo; Pompili, Sara; Zanna, Valeria; Castiglioni, Maria Chiara; Criscuolo, Michela; Chianello, Ilenia; Mazzoni, Silvia; Baiocco, Roberto

    2017-02-01

    This study aims at examining whether adolescent girls diagnosed with anorexia nervosa and their parents differ in perceiving the different aspects of family functioning. Moreover, the discrepancy between adolescent girls and healthy controls on Family Adaptability and Cohesion Evaluation Scales dimensions, family communication, and family satisfaction is investigated. The study includes 36 female anorexia patients and their parents and 36 healthy controls. The results showed a different view between mothers and their daughters with regard to the dimension of rigidity. In addition, girls with anorexia nervosa were less satisfied about family environment and rated their families as less communicative, flexible, cohesive, and more disengaged, compared to controls.

  14. Severity of eating disorder symptoms related to oxytocin receptor polymorphisms in anorexia nervosa.

    Science.gov (United States)

    Acevedo, Summer F; Valencia, Celeste; Lutter, Michael; McAdams, Carrie J

    2015-08-30

    Oxytocin is a peptide hormone important for social behavior and differences in psychological traits have been associated with variants of the oxytocin receptor gene in healthy people. We examined whether single nucleotide polymorphisms (SNPs) of the oxytocin receptor gene (OXTR) correlated with clinical symptoms in women with anorexia nervosa, bulimia nervosa, and healthy comparison (HC) women. Subjects completed clinical assessments and provided DNA for analysis. Subjects were divided into four groups: HC, subjects currently with anorexia nervosa (AN-C), subjects with a history of anorexia nervosa but in long-term weight recovery (AN-WR), and subjects with bulimia nervosa (BN). Five SNPs of the oxytocin receptor were examined. Minor allele carriers showed greater severity in most of the psychiatric symptoms. Importantly, the combination of having had anorexia and carrying either of the A alleles for two SNPS in the OXTR gene (rs53576, rs2254298) was associated with increased severity specifically for ED symptoms including cognitions and behaviors associated both with eating and appearance. A review of psychosocial data related to the OXTR polymorphisms examined is included in the discussion. OXTR polymorphisms may be a useful intermediate endophenotype to consider in the treatment of patients with anorexia nervosa. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Motivation to change, coping, and self-esteem in adolescent anorexia nervosa

    DEFF Research Database (Denmark)

    Pauli, Dagmar; Aebi, Marcel; Winkler Metzke, Christa

    2017-01-01

    , the Eating Disorder Inventory, the Eating Attitudes Test, the Body Image Questionnaire, two questionnaires measuring Self-Related Cognitions and the Coping Across Situations Questionnaire. After a treatment period of nine months, clinical anorexia nervosa diagnosis and the body mass index were re...... Nervosa Stages of Change Questionnaire (ANSOCQ), including its relation to coping style and self-esteem. METHODS: N = 92 adolescents referred to an eating disorders outpatient clinic meeting criteria for anorexia nervosa gave written informed consent to participate in this study and completed the ANSOCQ...... motivation to change was related to higher self-esteem and a more active coping style. Higher (positive) ANSOCQ total scores predicted remission of anorexia nervosa after nine months of treatment. A higher score on 'attitudes and feelings' was a protective factor against drop-out from intervention...

  16. What can we learn from the history of male anorexia nervosa?

    Science.gov (United States)

    Zhang, Chengyuan

    2014-01-01

    The eating disorders literature has focussed on females and little is known of the male experience. The overall image this has generated suggests a young woman in conflict with socio-cultural pressures which associate thinness with beauty. Historical studies have examined anorexia nervosa from an entirely female focus while ignoring how diagnostic categories have shaped approaches to the male body. This paper will track the case of the male with anorexia nervosa through changing theories of causation and treatment approaches, from when the condition first emerged in 1873 to the present. In doing so, we gain a valuable new insight into how anorexia nervosa has been historically gendered and the far-reaching implications this has had for diagnosis and treatment of the male sufferer. Similarities between the sexes helped to establish male anorexia as a distinct category. However, this shifted focus away from important differences, which have yet unexplored implications in the assessment, diagnosis and management of disordered eating. Throughout history, there has been constant pressure to give a precise definition to anorexia nervosa, despite being fraught with medical uncertainties. This has resulted in inevitably harmful generalisations rooted in the dominant epidemiology. This paper reveals that anorexia nervosa is a truly global phenomenon which cannot be adequately constructed through exclusive studies of the female. There is consequently a pressing need to address the dearth of research examining eating disorders in males.

  17. Phobic memory and somatic vulnerabilities in anorexia nervosa: a necessary unity?

    Directory of Open Access Journals (Sweden)

    Myslobodsky Michael

    2005-09-01

    Full Text Available Abstract Anorexia nervosa is a clinically significant illness that may be associated with permanent medical complications involving almost every organ system. The paper raises a question whether some of them are associated with premorbid vulnerability such as subcellular ion channel abnormalities ('channelopathy' that determines the clinical expression of the bodily response to self-imposed malnutrition. Aberrant channels emerge as a tempting, if rather speculative alternative to the notion of cognitively-driven neurotransmitter modulation deficit in anorexia nervosa. The concept of channelopathies is in keeping with some characteristics of anorexia nervosa, such as a genetically-based predisposition to hypophagia, early onset, cardiac abnormalities, an appetite-enhancing efficacy of some antiepileptic drugs, and others. The purpose of this article is to stimulate further basic research of ion channel biophysics in relation to restrictive anorexia.

  18. Positive beliefs about anorexia nervosa and muscle dysmorphia are associated with eating disorder symptomatology.

    Science.gov (United States)

    Griffiths, Scott; Mond, Jonathan M; Murray, Stuart B; Touyz, Stephen

    2015-09-01

    The ego-syntonic nature of anorexia nervosa means that sufferers often deny their symptoms or experience them as positive or comforting. Positive beliefs about eating disorder symptoms may contribute to the development and/or maintenance of eating-disordered behaviour. To date, however, research in this field has been confined to women and anorexia nervosa. Given increasing scientific interest in muscle dysmorphia, a potential eating disorder with ego-syntonic qualities, there is a need to extend current research to include men and muscle dysmorphia. The present study examined whether positive beliefs about anorexia nervosa and muscle dysmorphia were associated with more marked eating disorder symptoms and explored sex differences in these associations. Male and female university students (n = 492) read descriptions of a male or female character with clinically significant symptoms of anorexia nervosa or muscle dysmorphia. Participants subsequently answered questions about the characters and completed a measure of disordered eating. Knowledge, personal history and interpersonal familiarity with the conditions were assessed. Results from two simultaneous multiple regressions showed that more positive beliefs about anorexia nervosa and muscle dysmorphia were uniquely associated with more eating disorder symptoms for both male and female participants. Effect sizes for these relationships were medium to large (partial eta-squared = 0.09-0.10). The relationships were not moderated by the sex of the participant, nor the sex of the character. Although preliminary, these findings suggest that, among young men and women, positive beliefs about anorexia nervosa and muscle dysmorphia may contribute to the development and maintenance of these conditions. Some symptoms of muscle dysmorphia may be perceived as ego-syntonic, providing another parallel with anorexia nervosa. © The Royal Australian and New Zealand College of Psychiatrists 2015.

  19. The lived experience of anorexia nervosa in adolescence, comparison of the points of view of adolescents, parents, and professionals: A metasynthesis.

    Science.gov (United States)

    Sibeoni, Jordan; Orri, Massimiliano; Colin, Stéphanie; Valentin, Marie; Pradère, Jerome; Revah-Levy, Anne

    2017-01-01

    Anorexia nervosa in adolescence has been increasingly documented in numerous quantitative and qualitative studies. Qualitative research, which focuses on subjective experience, is a well-established method to deepen our understanding and provide new insights about specific diseases. We conducted a metasynthesis of qualitative studies to explore how anorexia nervosa is experienced by adolescents, their families, and the health professionals who provide care for them and to compare their perspectives. Five databases (Medline, PsycINFO, CINHAL, EMBASE, SSCI; 1990-2015) were systematically searched for qualitative studies reporting participants' views about anorexia nervosa. Article quality was assessed with the Critical Appraisal Skills Program (CASP). We used thematic synthesis to examine and summarize the topics found in the articles selected and develop their central themes. We included 30 articles from seven different countries. Two domains of experience were inductively developed from the analysis: (1) constructs and beliefs about etiological theories of anorexia nervosa, and (2) the experience of the disease from the points of view of adolescents, parents, and healthcare providers. We found important disparities between the three stakeholders. The adolescents underlined the psychological and emotional aspects of their experience, while the visible state of these patients' bodies impeded the work of the professionals. These difficulties shed new light on the stakes of treatment of anorexia nervosa in adolescence, which must integrate both its psychological and physical components. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Reduced salience and default mode network activity in women with anorexia nervosa

    Science.gov (United States)

    McFadden, Kristina L.; Tregellas, Jason R.; Shott, Megan E.; Frank, Guido K.W.

    2014-01-01

    Background The neurobiology of anorexia nervosa is poorly understood. Neuronal networks contributing to action selection, self-regulation and interoception could contribute to pathologic eating and body perception in people with anorexia nervosa. We tested the hypothesis that the salience network (SN) and default mode network (DMN) would show decreased intrinsic activity in women with anorexia nervosa and those who had recovered from the disease compared to controls. The basal ganglia (BGN) and sensorimotor networks (SMN) were also investigated. Methods Between January 2008 and January 2012, women with restricting-type anorexia nervosa, women who recovered from the disease and healthy control women completed functional magnetic resonance imaging during a conditioned stimulus task. Network activity was studied using independent component analysis. Results We studied 20 women with anorexia nervosa, 24 recovered women and 24 controls. Salience network activity in the anterior cingulate cortex was reduced in women with anorexia nervosa (p = 0.030; all results false-discovery rate–corrected) and recovered women (p = 0.039) compared to controls. Default mode network activity in the precuneus was reduced in women with anorexia compared to controls (p = 0.023). Sensorimotor network activity in the supplementary motor area (SMA; p = 0.008), and the left (p = 0.028) and right (p = 0.002) postcentral gyrus was reduced in women with anorexia compared to controls; SMN activity in the SMA (p = 0.019) and the right postcentral gyrus (p = 0.008) was reduced in women with anorexia compared to recovered women. There were no group differences in the BGN. Limitations Differences between patient and control populations (e.g., depression, anxiety, medication) are potential confounds, but were included as covariates. Conclusion Reduced SN activity in women with anorexia nervosa and recovered women could be a trait-related biomarker or illness remnant, altering the drive to approach

  1. Interhemispheric functional connectivity in anorexia and bulimia nervosa.

    Science.gov (United States)

    Canna, Antonietta; Prinster, Anna; Monteleone, Alessio Maria; Cantone, Elena; Monteleone, Palmiero; Volpe, Umberto; Maj, Mario; Di Salle, Francesco; Esposito, Fabrizio

    2017-05-01

    The functional interplay between hemispheres is fundamental for behavioral, cognitive, and emotional control. Anorexia nervosa (AN) and bulimia nervosa (BN) have been largely studied with brain magnetic resonance imaging (MRI) in relation to the functional mechanisms of high-level processing, but not in terms of possible inter-hemispheric functional connectivity anomalies. Using resting-state functional MRI (fMRI), voxel-mirrored homotopic connectivity (VMHC) and regional inter-hemispheric spectral coherence (IHSC) were studied in 15 AN and 13 BN patients and 16 healthy controls (HC). Using T1-weighted and diffusion tensor imaging MRI scans, regional VMHC values were correlated with the left-right asymmetry of corresponding homotopic gray matter volumes and with the white matter callosal fractional anisotropy (FA). Compared to HC, AN patients exhibited reduced VMHC in cerebellum, insula, and precuneus, while BN patients showed reduced VMHC in dorso-lateral prefrontal and orbito-frontal cortices. The regional IHSC analysis highlighted that the inter-hemispheric functional connectivity was higher in the 'Slow-5' band in all regions except the insula. No group differences in left-right structural asymmetries and in VMHC vs. callosal FA correlations were significant in the comparisons between cohorts. These anomalies, not explained by structural changes, indicate that AN and BN, at least in their acute phase, are associated with a loss of inter-hemispheric connectivity in regions implicated in self-referential, cognitive control and reward processing. These findings may thus gather novel functional markers to explore aberrant features of these eating disorders. © 2016 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

  2. Mood spectrum comorbidity in patients with anorexia and bulimia nervosa.

    Science.gov (United States)

    Miniati, Mario; Benvenuti, Antonella; Bologna, Elena; Maglio, Alessandra; Cotugno, Biagio; Massimetti, Gabriele; Calugi, Simona; Mauri, Mauro; Dell'Osso, Liliana

    2016-10-20

    To investigate the presence of mood spectrum signs and symptoms in patients with anorexia nervosa, restricting subtype (AN-R) or bulimia nervosa (BN). 55 consecutive female patients meeting DSM-IV criteria for eating disorders (EDs) not satisfying DSM-IV criteria for Axis I mood disorders were evaluated with the Lifetime Mood Spectrum Self-Report (MOODS-SR) and the Mini-International Neuropsychiatric Interview (MINI). The MOODS-SR explored the subthreshold comorbidity for mood spectrum symptoms in patients not reaching the threshold for a mood disorder Axis I diagnosis. MOODS-SR included 161 items. Separate factor analyses of MOODS-SR identified 6 'depressive factors' and 9 'manic-hypomanic factors'. The mean total score of MOODS-SR was significantly higher in BN than in AN-R patients (97.5 ± 25.4 vs 61.1 ± 38.5, respectively; p = 0.0001). 63.6 % of the sample (n = 35) endorsed the threshold of ≥61 items, with a statistically significant difference between AN-R and BN (39.3 % vs 88.9 %; χ 2  = 14.6; df = 1; p = 0.0001). Patients with BN scored significantly higher than AN-R patients on several MOODS-SR factors: (a) MOODS-SR depressive component: 'depressive mood' (11.2 ± 7.4 vs 16.0 ± 5.8; p self-esteem' (1.1 ± 1.4 vs 2.1 ± 1.6; p definition of clinical phenotypes.

  3. Twelve-year course and outcome predictors of anorexia nervosa.

    Science.gov (United States)

    Fichter, Manfred M; Quadflieg, Norbert; Hedlund, Susanne

    2006-03-01

    The current study presents the long-term course of anorexia nervosa (AN) over 12 years in a large sample of 103 patients diagnosed according to criteria in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Assessments were made at the beginning of therapy, at the end of therapy, at the 2-year follow-up, at the 6-year follow-up, and at the 12-year follow-up. Self-rating and an expert-rating interview data were obtained. The participation rate at the 12-year follow-up was 88% of those alive. There was substantial improvement during therapy, a moderate (in many instances nonsignificant) decline during the first 2 years posttreatment, and further improvement from 3 to 12 years posttreatment. Based on a global 12-year outcome score, 27.5% had a good outcome, 25.3% an intermediate outcome, 39.6% had a poor outcome, and 7 (7.7%) were deceased. At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS). A total of 52.4% showed no major DSM-IV eating disorder and 0% had binge eating disorder (BED). Systematic-strictly empirically based-model building resulted in a parsimonious model including four predictors of unfavorable 12-year outcome explaining 45% of the variance, that is, sexual problems, impulsivity, long duration of inpatient treatment, and long duration of an eating disorder. Mortality was high and symptomatic recovery protracted. Impulsivity, symptom severity, and chronicity were the important factors for predicting the 12-year outcome.

  4. THE ENDOCRINOPATHIES OF MALE ANOREXIA NERVOSA: CASE SERIES.

    Science.gov (United States)

    Skolnick, Aren; Schulman, Rifka C; Galindo, Rodolfo J; Mechanick, Jeffrey I

    2016-01-01

    Anorexia nervosa (AN) is a serious disorder with associated morbidity and mortality, most commonly diagnosed in females. Existing literature on male anorexia is sparse, and a review of the endocrine effects of AN in males has not previously been published. Our objective is to highlight the clinical characteristics of AN in males as a routinely overlooked cause of multiple endocrinopathies and systemic illness in hospitalized patients. We present 4 cases (2 cases at The Mount Sinai Hospital; 2 cases at Long Island Jewish Hospital) of young men with hormonal dysfunction due to underlying AN. Pertinent de-identified data were collected from a chart review of cases seen on the endocrinology consult service at both hospitals. Institutional Review Board approval was not required for an observational report of the cases presented. Four young men with AN demonstrated evidence of multiple systemic complications from severe caloric and protein malnutrition. Varying degrees of endocrinopathies were present, including hypogonadotropic hypogonadism, hypercortisolemia, and nonthyroidal illness syndrome, resulting in bradycardia, gastroparesis, hypothermia, acute systolic heart failure, and erectile dysfunction. Ages at diagnosis were 20, 24, 23, and 20 years, with mean age 21.75 years. Most of the clinical effects from these endocrinopathies resolved with improved caloric intake and nutrition, although symptoms of hypogonadism persisted. This small case series highlights the importance of AN as a potential cause of multiple endocrinopathies in males. The heterogeneous presentations and varying degrees of clinical manifestations in our cohort emphasize the challenge in diagnosis. Increased awareness of AN in males is vital, as its prevalence is likely underestimated and appropriate diagnosis and treatment can ameliorate the metabolic dysfunction in a majority of cases. Further studies on males with eating disorders are needed to help guide diagnostic and therapeutic decisions.

  5. Processo de Enfermagem para pacientes com Anorexia Nervosa Proceso de Enfermería para pacientes con Anorexia Nerviosa Nursing Process to patients with Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Vanessa Pellegrino Toledo

    2011-02-01

    Full Text Available Relato de experiência da aplicação do Processo de Enfermagem a uma paciente portadora de Anorexia Nervosa, utilizando histórico, diagnósticos, intervenções e resultados de enfermagem. As intervenções foram fundamentadas nos diagnósticos de enfermagem: distúrbio da imagem corporal, nutrição desequilibrada menos que as necessidades corporais, ansiedade, baixa autoestima crônica, intolerância a atividade, controle ineficaz do regime terapêutico, risco de infecção, volume de líquidos deficiente e isolamento social. A partir da aplicação do Processo de Enfermagem, os resultados planejados foram alcançados, proporcionando melhor qualidade de vida, no período em que permaneceu internada. Os fatores psíquicos, neurológicos, endócrinos e imunológicos, peculiares na anorexia nervosa, propiciaram a elaboração de um Processo de Enfermagem, que contribuiu de maneira positiva para a complementação da reabilitação da saúde da mesmaRelato de experiencia de la aplicación del proceso de enfermería (PE a una paciente portadora de Anorexia Nerviosa, utilizando histórico, diagnósticos, intervenciones y resultados de enfermería. Las intervenciones fueron basadas en los diagnósticos de enfermería: trastorno de la imagen corporal, nutrición alterada ingesta inferior a las necesidades corporales, ansiedad, autoestima baja crónica, intolerancia a la actividad, manejo ineficaz del régimen terapéutico, riesgo de infección, déficits de volumen de líquidos y aislamiento social. A partir de la aplicación del Proceso de Enfermería, los resultados planeados fueron alcanzados, proporcionando mejor calidad de vida en el período en que permaneció hospitalizada. Los factores psíquicos, neurológicos, endócrinos y inmunológicos, peculiares en la anorexia nerviosa, propiciaron la elaboración de un Proceso de Enfermería, que contribuyó de manera positiva para la complementación de la rehabilitación de su salud

  6. A history of the identification of the characteristic eating disturbances of Bulimia Nervosa, Binge Eating Disorder and Anorexia Nervosa.

    Science.gov (United States)

    Heaner, Martica K; Walsh, B Timothy

    2013-06-01

    During the last 25 years, the careful examination of the eating behavior of individuals with eating disorders has provided critical insights into the nature of these disorders. Crucially, studies investigating components of different eating behaviors have documented that Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED) are characterized by objective disturbances in eating patterns that are significantly different than behaviors exhibited by individuals who do not have these eating disorders. The detailed description of the disturbances in eating behavior has helped to identify diagnostic criteria associated with each disorder, and has led to important hypotheses about the underlying pathophysiology. These advances in understanding have provided, and continue to provide, a foundation for translational research and for the development of novel treatment interventions. This review is based on a presentation given by B. Timothy Walsh, M.D. at the 40th anniversary symposium of the Columbia University Appetite talks outlining the evolution of the discovery of the characteristic eating disturbances seen with each disorder. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Computerized assessment of body image in anorexia nervosa and bulimia nervosa: comparison with standardized body image assessment tool.

    Science.gov (United States)

    Caspi, Asaf; Amiaz, Revital; Davidson, Noa; Czerniak, Efrat; Gur, Eitan; Kiryati, Nahum; Harari, Daniel; Furst, Miriam; Stein, Daniel

    2017-02-01

    Body image disturbances are a prominent feature of eating disorders (EDs). Our aim was to test and evaluate a computerized assessment of body image (CABI), to compare the body image disturbances in different ED types, and to assess the factors affecting body image. The body image of 22 individuals undergoing inpatient treatment with restricting anorexia nervosa (AN-R), 22 with binge/purge AN (AN-B/P), 20 with bulimia nervosa (BN), and 41 healthy controls was assessed using the Contour Drawing Rating Scale (CDRS), the CABI, which simulated the participants' self-image in different levels of weight changes, and the Eating Disorder Inventory-2-Body Dissatisfaction (EDI-2-BD) scale. Severity of depression and anxiety was also assessed. Significant differences were found among the three scales assessing body image, although most of their dimensions differentiated between patients with EDs and controls. Our findings support the use of the CABI in the comparison of body image disturbances in patients with EDs vs. Moreover, the use of different assessment tools allows for a better understanding of the differences in body image disturbances in different ED types.

  8. Molecular bases of anorexia nervosa, bulimia nervosa and binge eating disorder: shedding light on the darkness.

    Science.gov (United States)

    Cuesto, Germán; Everaerts, Claude; León, Leticia G; Acebes, Angel

    2017-12-01

    Eating-disorders (EDs) consequences to human health are devastating, involving social, mental, emotional, physical and life-threatening aspects, concluding on impairment and death in cases of extreme anorexia nervosa. It also implies that people suffering an ED need to find psychiatric and psychological help as soon as possible to achieve a fully physical and emotional recovery. Unfortunately, to date, there is a crucial lack of efficient clinical treatment to these disorders. In this review, we present an overview concerning the actual pharmacological and psychological treatments, the knowledge of cells, circuits, neuropeptides, neuromodulators and hormones in the human brain- and other organs- underlying these disorders, the studies in animal models and, finally, the genetic approaches devoted to face this challenge. We will also discuss the need for new perspectives, avenues and strategies to be developed in order to pave the way to novel and more efficient therapeutics.

  9. Characteristics of autism spectrum disorder in anorexia nervosa: A naturalistic study in an inpatient treatment programme.

    Science.gov (United States)

    Tchanturia, Kate; Adamson, James; Leppanen, Jenni; Westwood, Heather

    2017-11-01

    Previous research has demonstrated links between anorexia nervosa and autism spectrum disorder however, few studies have examined the possible impact of symptoms of autism spectrum disorder on clinical outcomes in anorexia nervosa. The aim of this study was to examine the association between symptoms of autism spectrum disorder and eating disorders, and other psychopathology during the course of inpatient treatment in individuals with anorexia nervosa. Participants with anorexia nervosa (n = 171) completed questionnaires exploring eating disorder psychopathology, symptoms of depression and anxiety, and everyday functioning at both admission and discharge. Characteristics associated with autism spectrum disorder were assessed using the Autism Spectrum Quotient, short version. Autism spectrum disorder symptoms were significantly positively correlated with eating disorder psychopathology, work and social functioning, and symptoms of depression and anxiety, but not with body mass index. Autism Spectrum Quotient, short version scores remained relatively stable from admission to discharge but there was a small, significant reduction in scores. There was no interaction between time and Autism Spectrum Quotient, short version scores on clinical symptom change. In anorexia nervosa, autism spectrum disorder symptoms appear to be associated with a more severe clinical presentation on admission to inpatient care. Autism spectrum disorder symptoms as assessed by self-report measures may be exacerbated by other mental health psychopathology, which warrants further investigation.

  10. Definition of a gastric emptying abnormality in patients with anorexia nervosa

    International Nuclear Information System (INIS)

    McCallum, R.W.; Grill, B.B.; Lange, R.; Planky, M.; Glass, E.E.; Greenfeld, D.G.

    1985-01-01

    Upper gastrointestinal symptoms may be prominent in anorexia nervosa. This study is an investigation of the gastric emptying of solid and liquid meal components in 16 female patients who met accepted psychiatric diagnostic criteria for anorexia nervosa. The results were compared with those of gastric emptying studies in 10 normal females of ideal body weight, 13 normal persons (12 males), and six patients with weight loss secondary to Crohn's disease with no psychiatric symptoms. A dual-isotope technique using chicken liver intracellularly labeled with technetium-/sup 99m/ (/sup 99m/Tc) bound to sulfur colloid as the solid-phase marker, and indium- 111 ( 111 In) -labeled water as the liquid-phase marker was used. In 13 of the 16 anorexia nervosa patients (80%), gastric emptying of solids was slower than the range in the two groups of normal subjects, and mean gastric emptying was significantly slower than in the weight-loss patients. Liquid emptying (water) in anorexia nervosa was normal and similar to the control groups studied. In 11 of the anorexia nervosa patients with delayed gastric emptying, intramuscular metoclopramide, 10 mg, significantly accelerated the mean gastric emptying from 60 through 120 min after the meal. The authors conclude that these data are consistent with an antral motility disturbance, either primary or secondary; and metoclopramide, a gastric prokinetic agent, accelerates (delayed) gastric emptying

  11. Two diagnoses become one? Rare case report of anorexia nervosa and Cushing’s syndrome

    Directory of Open Access Journals (Sweden)

    Sawicka N

    2013-03-01

    Full Text Available Nadia Sawicka,* Maria Gryczyńska,* Jerzy Sowiński, Monika Tamborska-Zedlewska, Marek Ruchała Department of Endocrinology, Metabolism and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland*These authors contributed equally to this workAbstract: Hypothalamic-pituitary-adrenal axis impairment in anorexia nervosa is marked by hypercortisolemia, and psychiatric disorders occur in the majority of patients with Cushing’s syndrome. Here we report a patient diagnosed with anorexia nervosa who also developed Cushing’s syndrome. A 26-year-old female had been treated for anorexia nervosa since she was 17 years old, and also developed depression and paranoid schizophrenia. She was admitted to the Department of Endocrinology, Metabolism, and Internal Medicine with a preliminary diagnosis of Cushing’s syndrome. Computed tomography revealed a 27 mm left adrenal tumor, and she underwent laparoscopic adrenalectomy. She was admitted to hospital 6 months after this procedure, at which time she did not report any eating or mood disorder. This is a rare case report of a patient with anorexia nervosa in whom Cushing’s syndrome was subsequently diagnosed. Diagnostic difficulties were caused by the signs and symptoms presenting in the course of both disorders, ie, hypercortisolemia, osteoporosis, secondary amenorrhea, striae, hypokalemia, muscle weakness, and depression.Keywords: anorexia nervosa, Cushing’s syndrome, adrenalectomy, osteoporosis

  12. The CT appearance of ``reversible`` cerebral pseudoatrophy in anorexia nervosa; Obraz KT ``odwracalnego`` rzekomego zaniku mozgu w jadlowstrecie nerwowym

    Energy Technology Data Exchange (ETDEWEB)

    Boron, Z.; Kozlowska, R.; Grzegorzewski, M.; Nawrot, M.; Bulawska, I. [Katedra i Zaklad Radiologii i Diagnostyki Narzadowej, Akademia Medyczna, Bydgoszcz (Poland)

    1995-12-31

    The CT appearance of ``reversible`` cerebral pseudoatrophy resulting from anorexia nervosa was demonstrated. The CT studies were performed in 3 young women with typical clinical course of anorexia nervosa. In all of them computed tomography revealed dilatation of the subarachnoid fluid space. After 5 months of therapy the follow-up scans have reverted to normal in all cases. (author) 5 refs, 2 figs

  13. Anorexia nervosa, depression and suicidal thoughts among Chinese adolescents: a national school-based cross-sectional study.

    Science.gov (United States)

    Lian, Qiguo; Zuo, Xiayun; Mao, Yanyan; Luo, Shan; Zhang, Shucheng; Tu, Xiaowen; Lou, Chaohua; Zhou, Weijin

    2017-04-04

    Although there is much literature on adolescent suicide, combined effects of depression and anorexia nervosa on suicide were rarely investigated. The aims of this study are to examine the association between anorexia nervosa and suicidal thoughts and explore the interaction between anorexia nervosa and depression. This is a cross-sectional study, in the study, a sample of 8,746 Chinese adolescents was selected by multistage stratified method in 2012/2013 from 20 middle schools in 7 provinces across China Mainland. Multilevel logistic model was introduced to explore association between anorexia nervosa and suicidal thoughts. And subgroup analyses were conducted on participants with or without depression. Multilevel logistic model revealed that demographic variables, including academic achievement, were not the predictive risk factors of suicidal thoughts. Those who suffered from worse severity of perceived anorexia nervosa were at increased risk of thinking about suicide. The interaction between depression and anorexia nervosa was significant, however, subgroup analyses showed that the associations were significant only among the adolescents without depression. Our results indicate that all levels of anorexia nervosa serve as predictable indicators of suicidal thoughts in Chinese adolescents, and the effects of anorexia nervosa are modified by depression status.

  14. Dying on the Inside: What Every Teacher Needs to Know About Anorexia Nervosa, Bulimia, and the Individual Child.

    Science.gov (United States)

    Zimmer, Marc

    This document provides teachers with information on the identifying features of anorexia nervosa and bulimia and suggests steps which teachers can take to encourage individual children in more positive behavior. The paper makes clear distinctions between anorexia nervosa, bulimia, and bulimarexia, describing the symptoms of each disorder. It is…

  15. Core psychopathology in anorexia nervosa and bulimia nervosa: A network analysis.

    Science.gov (United States)

    Forrest, Lauren N; Jones, Payton J; Ortiz, Shelby N; Smith, April R

    2018-04-25

    The cognitive-behavioral theory of eating disorders (EDs) proposes that shape and weight overvaluation are the core ED psychopathology. Core symptoms can be statistically identified using network analysis. Existing ED network studies support that shape and weight overvaluation are the core ED psychopathology, yet no studies have estimated AN core psychopathology and concerns exist about the replicability of network analysis findings. The current study estimated ED symptom networks among people with anorexia nervosa (AN) and bulimia nervosa (BN) and among a combined group of people with AN and BN. Participants were girls and women with AN (n = 604) and BN (n = 477) seeking residential ED treatment. ED symptoms were assessed with the Eating Disorder Examination-Questionnaire (EDE-Q); 27 of the EDE-Q items were included as nodes in symptom networks. Core symptoms were determined by expected influence and strength values. In all networks, desiring weight loss, restraint, shape and weight preoccupation, and shape overvaluation emerged as the most important symptoms. In addition, in the AN and combined networks, fearing weight gain emerged as an important symptom. In the BN network, weight overvaluation emerged as another important symptom. Findings support the cognitive-behavioral premise that shape and weight overvaluation are at the core of AN psychopathology. Our BN and combined network findings provide a high degree of replication of previous findings. Clinically, findings highlight the importance of considering shape and weight overvaluation as a severity specifier and primary treatment target for people with EDs. © 2018 Wiley Periodicals, Inc.

  16. Differential impairments underlying decision making in anorexia nervosa and bulimia nervosa: a cognitive modeling analysis.

    Science.gov (United States)

    Chan, Trista Wai Sze; Ahn, Woo-Young; Bates, John E; Busemeyer, Jerome R; Guillaume, Sebastien; Redgrave, Graham W; Danner, Unna N; Courtet, Philippe

    2014-03-01

    This study examined the underlying processes of decision-making impairments in individuals with anorexia nervosa (AN) and bulimia nervosa (BN). We deconstructed their performance on the widely used decision task, the Iowa Gambling Task (IGT) into cognitive, motivational, and response processes using cognitive modeling analysis. We hypothesized that IGT performance would be characterized by impaired memory functions and heightened punishment sensitivity in AN, and by elevated sensitivity to reward as opposed to punishment in BN. We analyzed trial-by-trial data of IGT obtained from 224 individuals: 94 individuals with AN, 63 with BN, and 67 healthy comparison individuals (HC). The prospect valence learning model was used to assess cognitive, motivational, and response processes underlying IGT performance. Individuals with AN showed marginally impaired IGT performance compared to HC. Their performance was characterized by impairments in memory functions. Individuals with BN showed significantly impaired IGT performance compared to HC. They showed greater relative sensitivity to gains as opposed to losses than HC. Memory functions in AN were positively correlated with body mass index. This study identified differential impairments underlying IGT performance in AN and BN. Findings suggest that impaired decision making in AN might involve impaired memory functions. Impaired decision making in BN might involve altered reward and punishment sensitivity. Copyright © 2013 Wiley Periodicals, Inc.

  17. Childhood trauma and cortisol awakening response in symptomatic patients with anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Monteleone, Alessio Maria; Monteleone, Palmiero; Serino, Ismene; Scognamiglio, Pasquale; Di Genio, Monica; Maj, Mario

    2015-09-01

    Exposure to trauma during childhood is a risk factor for eating disorders (EDs) in adulthood. The biological mechanisms underlying such increased risk seem to involve the endogenous stress response system (i.e., the hypothalamic-pituitary-adrenal [HPA] axis), which undergoes trauma-induced functional changes that may persist later in life. In the present study, we examined the effects of childhood trauma experiences on HPA-axis activity, comparing saliva cortisol awakening response (CAR) in adult patients with anorexia nervosa (AN) or bulimia nervosa (BN) with CAR in adult healthy controls. Twenty-three patients with symptomatic AN, 21 patients with symptomatic BN, and 29 healthy women collected saliva samples at awakening and again after 15, 30, and 60 min. Participants also completed the Childhood Trauma Questionnaire and eating-related psychopathological rating scales. According to the Childhood Trauma Questionnaire, 13 individuals with AN and 12 individuals with BN, but none of the healthy women, reported childhood maltreatment. Compared with the control group, the non-maltreated AN patient group exhibited an enhanced CAR, whereas the group of non-maltreated BN patients showed a normal CAR. Moreover, both AN and BN patient groups with childhood maltreatment exhibited statistically significant blunting of CAR compared with non-maltreated groups. The present findings add to the evidence supporting the concept that there is a dysregulation of HPA-axis activity in symptomatic patients with EDs and suggest that childhood trauma exposure may contribute to such dysregulation. © 2014 Wiley Periodicals, Inc.

  18. Anorexia nervosa versus bulimia nervosa: differences based on retrospective correlates in a case-control study.

    Science.gov (United States)

    Machado, Bárbara C; Gonçalves, Sónia F; Martins, Carla; Brandão, Isabel; Roma-Torres, António; Hoek, Hans W; Machado, Paulo P

    2016-06-01

    This study is the result of two Portuguese case-control studies that examined the replication of retrospective correlates and preceding life events in anorexia nervosa (AN) and bulimia nervosa (BN) development. This study aims to identify retrospective correlates that distinguish AN and BN METHOD: A case-control design was used to compare a group of women who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for AN (N = 98) and BN (N = 79) with healthy controls (N = 86) and with other psychiatric disorders (N = 68). Each control group was matched with AN patients regarding age and parental social categories. Risk factors were assessed by interviewing each person with the Oxford Risk Factor Interview. Compared to AN, women with BN reported significantly higher rates of paternal high expectations, excessive family importance placed on fitness/keeping in shape, and negative consequences due to adolescent overweight and adolescent objective overweight. Overweight during adolescence emerged as the most relevant retrospective correlate in the distinction between BN and AN participants. Family expectations and the importance placed on keeping in shape were also significant retrospective correlates in the BN group.

  19. Orofacial manifestations in outpatients with anorexia nervosa and bulimia nervosa focusing on the vomiting behavior.

    Science.gov (United States)

    Lourenço, Maria; Azevedo, Álvaro; Brandão, Isabel; Gomes, Pedro S

    2017-11-25

    This case-control study aims to evaluate the oral health status and orofacial problems in a group of outpatients with eating disorders (ED)-either anorexia nervosa (AN) or bulimia nervosa (BN)-further focusing on the influence of vomit. Fifty-five women outpatients with AN or BN diagnosis were invited to participate, of which 33 agreed. ED outpatients and matched controls were submitted to a questionnaire and clinical oral examination. Multivariate analysis identified a significantly higher incidence of teeth-related complications (i.e., tooth decay, dental erosion, and self-reported dentin hypersensitivity), periodontal disease, salivary alterations (i.e., hyposalivation and xerostomia), and oral mucosa-related complications in ED outpatients. Dental erosion, self-reported dentin hypersensitivity, hyposalivation, xerostomia, and angular cheilitis were found to be highly correlated with the vomiting behavior. ED outpatients were found to present a higher incidence of oral-related complications and an inferior oral health status, compared to gender- and age-matched controls. Alterations verified within outpatients were acknowledged to be quite similar to those previously reported within inpatients, in both of nature and severity, thus sustaining that the cranio-maxillofacial region is significantly affected by ED, even in the early/milder forms of the condition, as expectedly verified within outpatients.

  20. The Impact of Alexithymia on Emotion Dysregulation in Anorexia Nervosa and Bulimia Nervosa over Time.

    Science.gov (United States)

    Brown, Tiffany A; Avery, Jade C; Jones, Michelle D; Anderson, Leslie K; Wierenga, Christina E; Kaye, Walter H

    2018-03-01

    Research supports that anorexia nervosa-restricting subtype (AN-R) and bulimia nervosa (BN) are associated with emotion regulation difficulties and alexithymia. However, the impact of diagnosis on the relationship between these constructs is less well understood. The purpose of the present study was to examine whether eating disorder diagnosis moderated the association between admission alexithymia and emotion regulation through discharge. Adult patients with AN-R (n = 54) and BN (n = 60) completed assessments at treatment admission and discharge from a partial hospital program. Eating disorder diagnosis moderated the association between admission alexithymia levels and change in global emotion dysregulation, impulse control difficulties and access to emotion regulation strategies. At higher levels of admission alexithymia, there were no differences between AN-R and BN on emotion dysregulation, whereas at lower levels of alexithymia, AN-R patients demonstrated lower levels of emotion dysregulation. Results imply that difficulties with alexithymia appear to have a greater impact on emotion dysregulation for AN-R patients. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

  1. Trail making task performance in inpatients with anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Vall, Eva; Wade, Tracey D

    2015-07-01

    Set-shifting inefficiencies have been consistently identified in adults with anorexia nervosa (AN). It is less clear to what degree similar inefficiencies are present in those with bulimia nervosa (BN). It is also unknown whether perfectionism is related to set-shifting performance. We employed a commonly used set-shifting measure, the Trail Making Test (TMT), to compare the performance of inpatients with AN and BN with a healthy control sample. We also investigated whether perfectionism predicted TMT scores. Only the BN sample showed significantly suboptimal performance, while the AN sample was indistinguishable from controls on all measures. There were no differences between the AN subtypes (restrictive or binge/purge), but group sizes were small. Higher personal standards perfectionism was associated with better TMT scores across groups. Higher concern over mistakes perfectionism predicted better accuracy in the BN sample. Further research into the set-shifting profile of individuals with BN or binge/purge behaviours is needed. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

  2. Characterization and correlates of exercise among adolescents with anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Nagata, Jason M; Carlson, Jennifer L; Kao, Jessica M; Golden, Neville H; Murray, Stuart B; Peebles, Rebecka

    2017-12-01

    To characterize exercise behaviors among adolescents with anorexia nervosa (AN), atypical AN, or bulimia nervosa (BN), and determine associations between exercise and medical risk. Cross-sectional electronic medical records of all patients evaluated by the Eating Disorder Program at Stanford between January 1997 and February 2011 were retrospectively reviewed. 1,083 subjects (961 females, 122 males; mean age 15.6) met eligibility criteria. Most patients (89.7%) reported exercise (mean 7.0 h per week over mean 5.4 days per week) prior to presentation. Running (49.9%), calisthenics (40.7%), walking (23.4%), soccer (20.9%), and swimming (18.2%) were the most common exercises; a majority (60.6%) reported team sport participation. Males were less likely to report team exercise (p = .005). Bradycardia (heart rate Adolescents with AN, atypical AN, and BN reported high levels of exercise. Females reported more team sport participation. Greater exercise frequency and team sport participation were associated with bradycardia. Further studies assessing the relationship between exercise and bradycardia may help inform the medical management of adolescents with these eating disorders who are more physically active. © 2017 Wiley Periodicals, Inc.

  3. [Purging behaviors and nutritional status in anorexia nervosa and bulimia nervosa].

    Science.gov (United States)

    Vaz, F J; García-Herráiz, A; López-Vinuesa, B; Monge, M; Fernández-Gil, M A; Guisado, J A

    2003-01-01

    The aim of the study was to investigate whether the use of purgative methods in patients with eating disorders (anorexia nervosa [AN] and bulimia nervosa [BN]) could be capable of producing changes in the nutritional status of the patients. The group under study was composed of 184 female eating disordered outpatients. One hundred and sixteen patients (63.0%) fulfilled the DSM-IV diagnostic criteria for BN (90 purging type, 26 nonpurging type). Sixty eight patients (37.0%) fulfilled the DSM-IV criteria for the diagnosis of AN (48 restricting type, 20 binging-purging type). The assessment process included anthropometry (body circumferences and skinfold thickness) and body impedance analysis. The two subgroups of AN patients significantly differed from each of the BN subgroups. From a nutritional point of view, some significant differences between the two DSM-IV subtypes of AN existed, but not between the purging type and the nonpurging type of BN. The paper discusses the clinical significance of these findings. An alternative subtypification of AN patients is proposed: 1) restricting type [patients who control their food intake and do not purge]; 2) purging type [patient with true episodes of binging which are followed by purgative behaviors]; and 3) pseudopurging type [patients with subjective binging episodes who use purging methods].

  4. Depression or depressiveness in patients diagnosed with Anorexia Nervosa and Bulimia Nervosa - pilot research.

    Science.gov (United States)

    Dêbska, Ewa; Janas, Adam; Bañczyk, Wojciech; Janas-Kozik, Małgorzata

    2011-09-01

    The target of this work is to consider if depressive symptoms intercurrent with patients suffering from Anorexia Nervosa (AN) and Bulimia Nervosa (BN) form a depression complex or whether they are physiological depression accompanying adolescence. We wished to observe the perception of these patients,of their functioning, both social and within their families and also looking for common point in the issues mentioned above trying to locate them within the course of the basic illness. We studied 19 patients suffering from eating disorders, and aged between 12 and 24 years old. 15 of them suffered from the restrictive form of AN and 4 suffered from BN. The control group consisted of 30 healthy girls in the same age interval. In the study authors used the Beck Depression Inventory (BDI) and the Quebec Quality of Life Questionnaire. Comparison of a number of points acquired in the survey using Beck Depression Scale revealed statistic significance at the level p0.05). The authors observed a statistically significant increased frequency of suicidal thoughts in the study group compared to the controls. To diagnose depression, depressive symptoms presented by the patients must give the image of depression at the clinical level. The result of the Beck's scale needs to be confronted with the clinical picture. Depression in adolescence requires differentiation from depressiveness.

  5. Are there differences in the attitudinal body image between adolescent anorexia nervosa and bulimia nervosa?

    Science.gov (United States)

    Ruuska, J; Kaltiala-Heino, R; Rantanen, P; Koivisto, A M

    2005-06-01

    Body image dissatisfaction is as well a risk factor for eating disorders (ED) and a central feature of ED. The exact nature of body image in adolescent ED is still debated. This study examined attitudinal body image in adolescent anorexia nervosa (AN) and bulimia nervosa (BN), and the association of age, maturational timing, duration of eating disorder, actual weight and general psychological distress with the attitudinal body image in ED. The study group consisted of an outpatient clinical sample of adolescents attending for assessment because of eating disorders. The attitudinal body image of 57 adolescents (girls) aged 14-21 years was studied at the beginning of the treatment. The attitudes to body shape, body size, appearance, tone and femininity were studied by a Likert format scale and by the body dissatisfaction (BD) and drive for thinness scales (DT) from EDI-2 inventory. Bulimics reported more body image dissatisfaction than anorectics. In multivariate analyses BN and higher general psychological distress had strong associations with body image dissatisfaction. Longer duration of ED and earlier menarche were also associated with negative body image. Attitudinal body image differs between adolescent AN and BN. The psychological distress has a great impact on body image in ED, which should be taken into account in assessment and in treatment interventions.

  6. A abordagem familiar no tratamento da anorexia e bulimia nervosa Family assessment in the treatment of anorexia and bulimia nervosa

    Directory of Open Access Journals (Sweden)

    Alicia Weisz Cobelo

    2004-01-01

    Full Text Available O final do século XX enfatiza a inclusão da família no tratamento de pacientes portadores de anorexia e bulimia nervosa. Pesquisas (Castro et al.,2000; Webster et al.,2000 colocam como relevante considerar a estrutura familiar, as práticas conversacionais e os legados transgeracionais como elementos que podem estar contribuindo, de modo significativo, no desenvolvimento ou na manutenção dos transtornos alimentares. No Ambulatório de Bulimia e Transtornos Alimentares e no Projeto de Atendimento a Crianças e Adolescentes do IPQ, o grande desafio dos terapeutas de família tem sido compartilhar com famílias e pacientes suas histórias repletas de inseguranças e angústias e construir uma ponte de união entre a família e a equipe multidisciplinar, para que a compreensão dos significados, refletida por todos, possa ser agilizada e transformada em novas contribuições de vida para as pacientes e seus familiares.The end of the 20th century emphasizes the inclusion of the family in the treatment of the patients with anorexia and bulimia nervosa. Researches (Castro et al.,2000; Webster et al.,2000 determine as relevant to consider the family structure, the interaction pattern, and the "transgeneration bequest" - the legacy that goes from one generation to the next - as elements that might contribute in a significant way to the development or maintenance of the eating disorders. At the Bulimia and Eating Disorders Ambulatory and in the IPQ's Project for Attendance of Children and Adolescents, the great challenge for the family therapists has been to share with the families and patients their histories full of insecurity and anguish. The therapists must also overcome the difficulties of building a bridge that brings together the family and the multidisciplinary team so that the comprehension of the meanings, reflected by all, might be quickly transformed into new life contributions to these patients and their families.

  7. Radionuclide gastric emptying studies in patients with anorexia nervosa

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    Domstad, P.A.; Shih, W.J.; Humphries, L.; DeLand, F.H.; Digenis, G.A.

    1987-05-01

    To evaluate gastric emptying in anorexia nervosa patients, 26 patients (17 females, two males, ranging in age from 13 to 40 yr) with upper GI symptoms ingested 150-200 microCi (/sup 99m/Tc)triethelenetetraamine polysterene resin in cereal and were imaged in the supine position. Data were accumulated at 5 min intervals to obtain the gastric emptying time (GET). The results of the studies were divided into three categories: prolonged, 13 patients; rapid, 11; and normal 3. Twelve of 13 patients with prolonged GET were given 10 mg metoclopramide i.v. injections; nine of the 12 patients had a good response and three had no response. Five of the nine patients underwent metoclopramide therapy and four of the patients showed benefit from the therapy. One patient discontinued metoclopramide therapy because of somnolence. Although all patients had subjective symptoms of gastric dysfunction, our results indicated only 50% had objectively prolonged GET, and another 50% showed normal or even rapid GET. Therefore, this radionuclide study enables quantitatively objective documentation of gastric emptying, separation of those patients with rapid or normal GET from those with prolonged GET, thereby avoiding the possible side effects from metoclopramide medication, and prediction of effectiveness of metoclopramide therapy in patients with prolonged GET.

  8. Radionuclide gastric emptying studies in patients with anorexia nervosa

    International Nuclear Information System (INIS)

    Domstad, P.A.; Shih, W.J.; Humphries, L.; DeLand, F.H.; Digenis, G.A.

    1987-01-01

    To evaluate gastric emptying in anorexia nervosa patients, 26 patients (17 females, two males, ranging in age from 13 to 40 yr) with upper GI symptoms ingested 150-200 microCi [/sup 99m/Tc]triethelenetetraamine polysterene resin in cereal and were imaged in the supine position. Data were accumulated at 5 min intervals to obtain the gastric emptying time (GET). The results of the studies were divided into three categories: prolonged, 13 patients; rapid, 11; and normal 3. Twelve of 13 patients with prolonged GET were given 10 mg metoclopramide i.v. injections; nine of the 12 patients had a good response and three had no response. Five of the nine patients underwent metoclopramide therapy and four of the patients showed benefit from the therapy. One patient discontinued metoclopramide therapy because of somnolence. Although all patients had subjective symptoms of gastric dysfunction, our results indicated only 50% had objectively prolonged GET, and another 50% showed normal or even rapid GET. Therefore, this radionuclide study enables quantitatively objective documentation of gastric emptying, separation of those patients with rapid or normal GET from those with prolonged GET, thereby avoiding the possible side effects from metoclopramide medication, and prediction of effectiveness of metoclopramide therapy in patients with prolonged GET

  9. The prevalence of peripheral neuropathy in patients with anorexia nervosa.

    Science.gov (United States)

    MacKenzie, J R; LaBan, M M; Sackeyfio, A H

    1989-11-01

    A prospective, controlled study was conducted to determine the prevalence of peripheral neuropathy (PN) in patients with anorexia nervosa (AN). Fifty-one patients (49 females, 2 males) between the ages of 12 and 47 (means = 22.5) who met the criteria for AN of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, were randomly selected from an inpatient eating disorders unit during 15 months. Fifty healthy volunteers (41 females, 9 males) between the ages of 17 and 50 (means = 26.5) served as controls. After a neurologic history, all patients were evaluated by physical examination and standardized electrodiagnostic testing. Chi-square contingency testing was used to assess data. Four study group patients (8%) had electrodiagnostic evidence of a sensorimotor PN compared with none in the control group. This is approaching statistical significance (p = 0.13). Three of four patients with AN for at least ten years were among those with PN. The prevalence of subjective symptoms among the study group (65%) as compared to the control group (4%) was of marked significance (p = 5.62 x 10(-10]. In addition, three anorexic patients were found to have an isolated peroneal nerve palsy. We conclude that PN is a notable complication of AN, particularly in long-standing cases. The PN is most likely a product of chronic malnutrition rather than a specific nutrient deficiency. Patients with AN also appear to be at increased risk for developing localized compression neuropathies secondary to subcutaneous tissue loss.

  10. Atypical antipsychotics as augmentation therapy in anorexia nervosa.

    Science.gov (United States)

    Marzola, Enrica; Desedime, Nadia; Giovannone, Cristina; Amianto, Federico; Fassino, Secondo; Abbate-Daga, Giovanni

    2015-01-01

    Anorexia nervosa (AN) is a life-threatening and difficult to treat mental illness with the highest mortality rates of any psychiatric disorder. We aimed to garner preliminary data on the real-world use of olanzapine and aripiprazole as augmentation agents of Selective Serotonin Reuptake Inhibitors (SSRIs) in adult inpatients affected by AN. We retrospectively evaluated the clinical charts of patients who were hospitalized between 2012 and 2014. Patients were evaluated upon admission and discharge. We investigated eating symptomatology, and both general and eating psychopathology using: Hamilton Rating Scale for Anxiety, Hamilton Rating Scale for Depression, and Yale-Brown-Cornell Eating Disorders Scale. The charts of 75 patients were included in this study. The sample resulted equally distributed among those receiving SSRIs and either aripiprazole or olanzapine in addition to SSRIs. Notwithstanding a few baseline clinical differences, upon discharge all groups were significantly improved on all measures. Interestingly, aripiprazole showed the greatest effectiveness in reducing eating-related preoccupations and rituals with a large effect size. The body of evidence on medication management in AN is in dismal condition. Augmentation therapy is a well-established approach to a variety of mental disorders and it is often used in every-day clinical practice with patients affected by AN as well. Nevertheless, to date very little data is available on this topic. Results from our sample yielded promising results on the effectiveness of aripiprazole augmentation in reducing eating-related obsessions and compulsions. Randomized controlled trials are warranted to confirm these encouraging findings.

  11. Clinical investigation of set-shifting subtypes in anorexia nervosa.

    Science.gov (United States)

    Abbate-Daga, Giovanni; Buzzichelli, Sara; Marzola, Enrica; Amianto, Federico; Fassino, Secondo

    2014-11-30

    While evidence continues to accumulate on the relevance of cognitive inflexibility in anorexia nervosa (AN), its clinical correlates remain unclear. We aimed at examining the relationship between set-shifting and clinical variables (i.e., eating psychopathology, depression, and personality) in AN. Ninety-four individuals affected by AN and 59 healthy controls (HC) were recruited. All participants were assessed using: Eating Disorders Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI), and Wisconsin Card Sorting Test (WCST). The AN group scored worse than HCs on set-shifting. According to their neuropsychological performances, AN patients were split into two groups corresponding to poor (N=30) and intact (N=64) set-shifting subtypes. Interoceptive awareness, impulse regulation, and maturity fears on the EDI-2 and depression on the BDI differed across all groups (HC, intact, and poor set-shifting subtype). Self-directedness on the TCI differed significantly among all groups. Cooperativeness and reward dependence differed instead only between HC and AN poor set-shifting subtype. After controlling for depression, only interoceptive awareness remained significant with reward dependence showing a trend towards statistical significance. These findings suggest that multiple clinical variables may be correlated with set-shifting performances in AN. The factors contributing to impaired cognitive inflexibility could be more complex than heretofore generally considered. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. [Blunted erythropoietic response in the anemia of anorexia nervosa].

    Science.gov (United States)

    Juncà, Jordi; Sorigué, Marc; Rodríguez-Hernández, Inés; Aldea, Marta; Granada, María Luisa; Sánchez-Planell, Lluis

    2015-11-20

    The cause of the anemia in anorexia nervosa (AN) has not been fully ascertained. Ferritin, folate and cobalamin values are usually within normal ranges. Anemia does not have a relationship with bone marrow changes and erythropoietin (EPO) levels have not been investigated. The objective of this study was to evaluate the EPO response in a small group of AN patients. EPO levels were measured in serum samples of 41 female AN patients (11 with anemia, and 30 with normal blood cell count). The adequacy of EPO response was assessed by comparing the increase observed in a group of normal weight patients with anemia. EPO concentrations in anemic AN patients were higher than in non-anemic: 20.63mU/mL (4.04-28.46) vs 8.7mU/mL (3.9-20.93), P=.0088, but the increase in EPO was lower than expected (27.85mU/mL [17.7-118.9]), P=.014. BMI and the difference between actual and expected EPO were inversely correlated. Inadequate EPO response may partly explain anemia in AN, but further studies are necessary. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  13. Psychopathology in elite rhythmic gymnasts and anorexia nervosa patients.

    Science.gov (United States)

    Klinkowski, Nora; Korte, Alexander; Pfeiffer, Ernst; Lehmkuhl, Ulrike; Salbach-Andrae, Harriet

    2008-03-01

    This study investigates current psychopathology and psychological distress in elite rhythmic gymnasts. Due to a strong emphasis on leanness in aesthetic sports and the controversial findings in literature regarding the role of anorexia nervosa (AN) in such sports, we compared elite rhythmic gymnasts (n=51) to inpatients with AN (n=55) as a disease control group and to high school students (n=53) as a "normal" control group. We assessed psychopathology using the Symptom Checklist (SCL-90-R). Moreover, body height, weight, Body Mass Index (BMI) and the presence of amenorrhea were assessed. Regarding physical aspects, the rhythmic gymnasts showed an intermediate position between the two other groups. In terms of psychopathology, significant differences were found between the gymnasts and the AN patients, while no differences were detected between the gymnasts and the "normal" control group. Depression discriminated best between the three groups. Elite rhythmic gymnasts may show a lean, almost anorexic-like physique. Nevertheless, no psychological distress comparable to that of AN patients was found. Therefore, even though analogies to AN might seem obvious in elite rhythmic gymnasts, this study is putting emphasis on the importance of a careful consideration of psychological distress and psychopathology.

  14. Choice of diet in patients with anorexia nervosa.

    Science.gov (United States)

    Jáuregui Lobera, I; Bolaños Ríos, P

    2009-01-01

    To analyse the diets chosen by anorexic patients and a control group, assessing several nutritional aspects. Forty-four outpatients with an initial diagnosis of restrictive anorexia nervosa (normal BMI at the time of the study) and 34 undergraduates chose their diet from a list of common foods. Nutritional content, frequency of consumption, and influence of illness and treatment duration on the diet chosen were all analysed. Patients' diets had a lower caloric content (P = 0.01). Their diets were also lower in niacin (P = 0.03), vitamin B12 (P = 0.04), sodium (P = 0.003), zinc (P = 0.04), phosphorus, copper and selenium (P = 0.01). Frequency of consumption was lower among patients for bread and cereals, meat and cured meats (P = 0.01), sweet foods (P = 0.001), and fatty and fried foods (P = 0.05), but higher for vegetables (P = 0.01). Patients tend to maintain some characteristic eating patterns and modify others, not so much in terms of therapeutic objectives but, rather, as a way of following more closely the usual eating patterns of the context.

  15. Heightened sensitivity to punishment and reward in anorexia nervosa.

    Science.gov (United States)

    Glashouwer, Klaske A; Bloot, Lotte; Veenstra, Esther M; Franken, Ingmar H A; de Jong, Peter J

    2014-04-01

    The aim of this study was to investigate reinforcement sensitivity in anorexia nervosa (AN). It was tested whether self-reported punishment (PS) and reward sensitivity (RS) differed between adolescents with AN and healthy controls, and/or between AN-subtypes. In addition, the predictive validity of PS and RS was examined for AN symptoms one year later. In total, 165 female adolescents admitted for treatment of AN or eating disorder not otherwise specified resembling AN and 72 controls participated in the study. Participants completed measurements for eating disorder severity and the Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ). Percentage of underweight and severity of AN symptoms were measured again after one year in individuals with AN. Individuals with AN scored higher on PS and RS than controls. In addition, the AN purging type showed higher PS than the AN restrictive type, whereas there were no differences in RS between AN-subtypes. Regression analyses indicated that PS and RS were independently associated with the degree of eating disorder symptoms, whereas only PS was related to percentage underweight. Yet, neither RS nor PS were related to percentage of underweight and AN symptoms after one year. Although the present study clearly demonstrated that heightened punishment and reward sensitivity are both linked to AN, there was no evidence that these characteristics are also involved in the course of AN symptoms. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Altered Medial Frontal Feedback Learning Signals in Anorexia Nervosa.

    Science.gov (United States)

    Bernardoni, Fabio; Geisler, Daniel; King, Joseph A; Javadi, Amir-Homayoun; Ritschel, Franziska; Murr, Julia; Reiter, Andrea M F; Rössner, Veit; Smolka, Michael N; Kiebel, Stefan; Ehrlich, Stefan

    2018-02-01

    In their relentless pursuit of thinness, individuals with anorexia nervosa (AN) engage in maladaptive behaviors (restrictive food choices and overexercising) that may originate in altered decision making and learning. In this functional magnetic resonance imaging study, we employed computational modeling to elucidate the neural correlates of feedback learning and value-based decision making in 36 female patients with AN and 36 age-matched healthy volunteers (12-24 years). Participants performed a decision task that required adaptation to changing reward contingencies. Data were analyzed within a hierarchical Gaussian filter model that captures interindividual variability in learning under uncertainty. Behaviorally, patients displayed an increased learning rate specifically after punishments. At the neural level, hemodynamic correlates for the learning rate, expected value, and prediction error did not differ between the groups. However, activity in the posterior medial frontal cortex was elevated in AN following punishment. Our findings suggest that the neural underpinning of feedback learning is selectively altered for punishment in AN. Copyright © 2017 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  17. A further assessment of decision-making in anorexia nervosa.

    Science.gov (United States)

    Adoue, C; Jaussent, I; Olié, E; Beziat, S; Van den Eynde, F; Courtet, P; Guillaume, S

    2015-01-01

    Anorexia nervosa (AN) may be associated with impaired decision-making. Cognitive processes underlying this impairment remain unclear, mainly because previous assessments of this complex cognitive function were completed with a single test. Furthermore, clinical features such as mood status may impact this association. We aim to further explore the hypothesis of altered decision-making in AN. Sixty-three adult women with AN and 49 female controls completed a clinical assessment and were assessed by three tasks related to decision-making [Iowa Gambling Task (IGT), Balloon Analogue Risk Task (BART), Probabilistic Reversal Learning Task (PRLT)]. People with AN had poorer performance on the IGT and made less risky choices on the BART, whereas performances were not different on PRLT. Notably, AN patients with a current major depressive disorder showed similar performance to those with no current major depressive disorder. These results tend to confirm an impaired decision making-process in people with AN and suggest that various cognitive processes such as inhibition to risk-taking or intolerance of uncertainty may underlie this condition Furthermore, these impairments seem unrelated to the potential co-occurent major depressive disorders. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  18. Anorexia nervosa: estudo de caso com uma abordagem de sucesso

    Directory of Open Access Journals (Sweden)

    Márcia Cecília Vianna Cañete

    2008-12-01

    Full Text Available A anorexia nervosa (AN é doença grave de etiologia multifatorial, que envolve predisposição genética, fatores socioculturais, vulnerabilidades biológicas e também psicológicas. Caracteriza-se por séria restrição alimentar auto-imposta, com conseqüências orgânicas e psíquicas graves, e alta taxa de mortalidade. O objetivo deste artigo é descrever um caso de AN, tratado em grupo psicoterápico, heterogêneo, de adolescentes, sem focar no comportamento anoréxico. Analisaram-se as implicações da doença nos aspectos familiar, social, na escolaridade e na sexualidade da paciente. O método terapêutico empregado, em grupo heterogêneo, sem focar no comportamento anoréxico, mostrou-se eficaz tanto na aderência ao tratamento quanto na evolução do caso.

  19. Heightened attentional capture by visual food stimuli in anorexia nervosa.

    Science.gov (United States)

    Neimeijer, Renate A M; Roefs, Anne; de Jong, Peter J

    2017-08-01

    The present study was designed to test the hypothesis that anorexia nervosa (AN) patients are relatively insensitive to the attentional capture of visual food stimuli. Attentional avoidance of food might help AN patients to prevent more elaborate processing of food stimuli and the subsequent generation of craving, which might enable AN patients to maintain their strict diet. Participants were 66 restrictive AN spectrum patients and 55 healthy controls. A single-target rapid serial visual presentation task was used with food and disorder-neutral cues as critical distracter stimuli and disorder-neutral pictures as target stimuli. AN spectrum patients showed diminished task performance when visual food cues were presented in close temporal proximity of the to-be-identified target. In contrast to our hypothesis, results indicate that food cues automatically capture AN spectrum patients' attention. One explanation could be that the enhanced attentional capture of food cues in AN is driven by the relatively high threat value of food items in AN. Implications and suggestions for future research are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  20. Autobiographical memory in adolescent girls with anorexia nervosa.

    Science.gov (United States)

    Bomba, Monica; Marfone, Mirella; Brivio, Elisa; Oggiano, Silvia; Broggi, Fiorenza; Neri, Francesca; Nacinovich, Renata

    2014-11-01

    The aim of the study is to investigate deficits in autobiographical memory in adolescents with anorexia nervosa (AN). Sixty female individuals with AN and 60 healthy volunteers with an age range of 11-18 years were enrolled. The Autobiographical Memory Test (AMT), the Eating Disorder Inventory-3, the Toronto Alexithymia Scale-20 for the evaluation of alexithymia and Children's Depression Inventory to evaluate depressive traits were administered. In addition to classical AMT words, we proposed seven experimental cues, chosen from words often used by individuals with eating disorders in daily life. Girls with AN showed a massive overgeneral memory effect. This effect was not related to the presence of depression or alexithymia but increased with the duration of the disorder rather than with its severity. The alteration of autobiographical memory manifests in adolescence. Girls with AN showed a dysregulation of both negative and positive emotional experiences that seemed to be influenced by the disease duration. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

  1. Alexithymia in anorexia nervosa: the mediating role of depression.

    Science.gov (United States)

    Torres, Sandra; Guerra, Marina Prista; Lencastre, Leonor; Miller, Kylee; Vieira, Filipa Mucha; Roma-Torres, António; Brandão, Isabel; Costa, Patrício

    2015-01-30

    The role of depression in the expression of alexithymia in anorexia nervosa (AN) has been controversially explained and several variables that may mask or increase the presence of emotional difficulties have scant examination in previous studies. This study aims to analyze the associations between alexithymia and state variables, such as age, BMI, illness duration, treatment duration, and medication status in AN participants, and to test the mediating role of depression in emotional difficulties. The Toronto Alexithymia Scale (TAS-20) and the Zung Self-Rating Depression Scale were administrated to 160 females: 80 participants with AN and 80 healthy controls. High levels of alexithymia were not a function of state variables. The mediating role of depression differed by the alexithymia dimension, with total mediation found for the TAS-DDF and partial mediation found for the TAS-DIF. Alexithymia is a relevant feature throughout the spectrum of AN and does not seem to be related to developmental maturation and some clinical features. Depression is probably the variable that best accounts for the variance in alexithymia, but is not a complete explanation for the known cognitive-affective disturbances in AN. Specific emotional competencies require scrutiny during psychiatric treatment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  2. Anorexia Nervosa and its Associated Endocrinopathy in Young People

    Science.gov (United States)

    Misra, Madhusmita; Klibanski, Anne

    2016-01-01

    Anorexia nervosa (AN) is a condition of severe undernutrition associated with adaptive changes in many endocrine axes. These changes include hypogonadotropic hypogonadism, acquired growth hormone resistance with low insulin like growth factor-1 (IGF-1) levels, hypercortisolemia, altered secretion of adipokines and appetite regulating hormones, and low bone mineral density (BMD). Bone health is impaired subsequent to low BMI, decreased lean mass, and the endocrine changes described above. In addition to low areal BMD, AN is characterized by a decrease in volumetric BMD, changes in bone geometry, and reductions in strength estimates, leading to an increased risk for fracture. Weight restoration is essential for restoration of normal endocrine function; however, hypercortisolemia, high PYY levels, and ghrelin dynamics may not completely normalize. In some patients, hypogonadotropic hypogonadism persists despite weight restoration. Weight gain and menstrual recovery are critical for improving bone health in AN, however, residual deficits may persist. Physiologic estrogen replacement using transdermal, but not oral, estrogen increases bone accrual in adolescents with AN, while bisphosphonates improve BMD in adults. Recombinant human IGF-1 and teriparatide have been used in a few studies as bone anabolic therapies. More data are necessary to determine the optimal therapeutic strategies for low BMD in AN. PMID:26863308

  3. Are adolescents with anorexia nervosa better at reading minds?

    Science.gov (United States)

    Laghi, Fiorenzo; Pompili, Sara; Zanna, Valeria; Castiglioni, Maria Chiara; Criscuolo, Michela; Chianello, Ilenia; Baumgartner, Emma; Baiocco, Roberto

    2015-01-01

    The present study aimed to investigate mindreading abilities in female adolescent patients with AN compared to healthy controls (HCs), analysing differences for emotional valence of facial stimuli. The Eating Disorder Inventory) for evaluating psychological traits associated with eating disorders and the Children's version of the Reading the Mind in the Eyes Test for evaluating mindreading abilities were administered to 40 Italian female patients (mean age = 14.93; SD = 1.48) with restrictive diagnosis of anorexia nervosa (AN) and 40 healthy females (mean age = 14.88; SD = 0.56). No significant differences between the AN group and HCs for the Eyes Total score were found. Even when analysing emotional valence of the items, the two groups were equally successful in the facial recognition of positive, negative and neutral emotions. A significant difference was revealed for the percentage of correct responses of item 10 and item 15, where the AN group was less able to correctly identify the target descriptor (Not believing) over the foils than HCs. A significant difference was revealed in discriminating for affective emotions versus cognitive states; only for affective but not for cognitive states, patients with AN were found to perform better than controls on the mindreading task. Our study highlighted the importance of analysing and discriminating for different valences of facial stimuli when assessing mindreading abilities in adolescents with AN, so that more precise and specific treatment approaches could be developed for female adolescents with AN.

  4. Cognitive profile of children and adolescents with anorexia nervosa.

    Science.gov (United States)

    Kjaersdam Telléus, Gry; Jepsen, Jens Richardt; Bentz, Mette; Christiansen, Eva; Jensen, Signe O W; Fagerlund, Birgitte; Thomsen, Per Hove

    2015-01-01

    Few studies of cognitive functioning in children and adolescents with anorexia nervosa (AN) have been conducted. The aim of this study was to examine the neurocognitive and intelligence profile of this clinical group. The study was a matched case-control (N = 188), multi-centre study including children and adolescents with AN (N = 94) and healthy control participants (N = 94). The results suggest that Full Scale Intelligence Quotient (Wechsler Intelligence Scale for Children-III/Wechsler Adult Intelligence Scale-III) in this patient group is close to the normal population mean of 100. Individuals with AN exhibited significantly worse performance in nonverbal intelligence functions (i.e. Wechsler Intelligence Scale for Children-III/Wechsler Adult Intelligence Scale-III, Perceptual Organization Index) and in verbal memory (Test of Memory and Learning-Second Edition, Memory for Stories) and motor speed (Cambridge Neuropsychological Test Automated Battery, Simple and Choice Reaction Time) compared with healthy control participants. No significant difference in set-shifting ability (Cambridge Neuropsychological Test Automated Battery, Intra-Extra Dimensional Set Shift and Trail Making Test B) was found. Inefficiency in nonverbal intelligence functions and in specific cognitive functions was found in this study of children and adolescents with AN. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd.

  5. Cognitive distortions in anorexia nervosa and borderline personality disorder.

    Science.gov (United States)

    Del Pozo, Melina Andrea; Harbeck, Susanne; Zahn, Sabine; Kliem, Sören; Kröger, Christoph

    2017-11-21

    Thought-shape fusion (TSF) is a cognitive distortion associated with eating disorders (ED). A similar distortion, thought-abandonment fusion (TAbF), is assumed to occur in borderline personality disorder (BPD). In this study the specificity of TSF in participants with anorexia nervosa (AN) and TAbF in participants with BPD was examined. 63 patients completed questionnaires assessing the manifestation of trait-TAbF and trait-TSF, as well as relevant psychopathology. Nonparametric conditional inference trees were used to test for cognitive disorder-specificity. Participants with AN exhibited higher trait-TSF-scores than those with BPD, when participants with BPD and a co-occurring AN were removed. Trait-TSF in participants with AN seemed to be disorder-specific. Participants with BPD and a co-occurring AN had the highest TAbF-scores. The specificity hypothesis could only be partially confirmed for trait-TAbF: while participants with BPD and a co-occurring AN tended to have the highest trait-TAbF scores, high mean values could also be found in participants with AN. The results indicate that TAbF is not specific to BPD, but may also play a role in AN. Both distortions seem to play a role in the maintenance of the respective disorders. Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Self-esteem in patients treated for anorexia nervosa.

    Science.gov (United States)

    Karpowicz, Ewa; Skärsäter, Ingela; Nevonen, Lauri

    2009-10-01

    Anorexia nervosa (AN) mainly affects girls or women between 13 and 45 years of age. According to previous studies, one of the reasons for the desire to be thin is low self-esteem. The purpose of the study was to examine the self-esteem of 38 female patients with AN between 16 and 25 years of age, before and after 3 months of treatment at a specialist ward for eating disorders in Göteborg, Sweden. A quantitative pre- and post-assessment based on two self-rating questionnaires, the Rosenberg Self-Esteem Scale (RSE-S) and three subscales (weight phobia, body dissatisfaction, and ineffectiveness) of Eating Disorder Inventory-2 (EDI-2), together with body mass index (BMI), were used in the study, which was conducted between June 2005 and March 2008. The results reveal that self-esteem, BMI, weight phobia, and body dissatisfaction improved significantly between pre- and post-treatment. The RSE-S and EDI-2 ineffectiveness correlate highly with one another, which lends support to convergent validity, and the internal consistency was high for both the RSE-S and EDI-2 ineffectiveness. The results indicate that the treatment was effective, as both patients' self-esteem and BMI increased after completed treatment, which was the primary goal of the treatment at this ward. Future studies should focus on follow up and the way self-esteem manifests itself at different points in time within an individual.

  7. Body image related negative interpretation bias in anorexia nervosa.

    Science.gov (United States)

    Brockmeyer, Timo; Anderle, Alisa; Schmidt, Hagen; Febry, Stephanie; Wünsch-Leiteritz, Wally; Leiteritz, Andreas; Friederich, Hans-Christoph

    2018-03-14

    A distorted body image and pronounced body dissatisfaction are hallmarks of anorexia nervosa (AN) that typically result in dietary restraint and compensatory behaviours. Cognitive biases such as negative interpretation bias are considered key maintaining factors of these maladaptive cognitions and behaviours. However, little attention has been paid to empirical tests whether negative interpretation bias exists in AN and to what degree it is associated with symptom severity. Participants in the present study were 40 women with AN and 40 healthy women with no history of an eating disorder. Body-related negative interpretation bias (i.e., a tendency to interpret ambiguous information about the own body in a negative way) was measured by a Scrambled Sentences Task. Patients with AN showed a stronger body-related negative interpretation bias than healthy controls. Within both groups, negative interpretation bias correlated strongly and positively with AN symptom severity and these effects were not moderated by levels of depressive symptoms. The findings support the idea that biased interpretation of body-related information is associated with the specific psychopathology of AN. Targeted, computerised interventions (e.g. interpretation bias modification) may help to alter these dysfunctional cognitive schemas that lie at the heart of AN. Copyright © 2018 Elsevier Ltd. All rights reserved.

  8. Impaired processing of self-face recognition in anorexia nervosa.

    Science.gov (United States)

    Hirot, France; Lesage, Marine; Pedron, Lya; Meyer, Isabelle; Thomas, Pierre; Cottencin, Olivier; Guardia, Dewi

    2016-03-01

    Body image disturbances and massive weight loss are major clinical symptoms of anorexia nervosa (AN). The aim of the present study was to examine the influence of body changes and eating attitudes on self-face recognition ability in AN. Twenty-seven subjects suffering from AN and 27 control participants performed a self-face recognition task (SFRT). During the task, digital morphs between their own face and a gender-matched unfamiliar face were presented in a random sequence. Participants' self-face recognition failures, cognitive flexibility, body concern and eating habits were assessed with the Self-Face Recognition Questionnaire (SFRQ), Trail Making Test (TMT), Body Shape Questionnaire (BSQ) and Eating Disorder Inventory-2 (EDI-2), respectively. Subjects suffering from AN exhibited significantly greater difficulties than control participants in identifying their own face (p = 0.028). No significant difference was observed between the two groups for TMT (all p > 0.1, non-significant). Regarding predictors of self-face recognition skills, there was a negative correlation between SFRT and body mass index (p = 0.01) and a positive correlation between SFRQ and EDI-2 (p recognition.

  9. [Personality disorders in adolescent patients with anorexia and bulimia nervosa].

    Science.gov (United States)

    Bottin, Julia; Salbach-Andrae, Harriet; Schneider, Nora; Pfeiffer, Ernst; Lenz, Klaus; Lehmkuhl, Ulrike

    2010-09-01

    The present study aimed to ascertain the occurrence of personality disorders (PD) in adolescent patients with anorexia (AN) and bulimia nervosa (BN) by means of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). 99 female adolescent patients (57 AN - restrictive type, 17 AN - binge-purging type, 25 BN; M(age) = 16.3 +/- 1.6) were consecutively assessed by means of SCID-II. Furthermore, the influence of age, axis-I-comorbidities, and type of treatment according to PD were examined. 30.3% of the patients met the criteria for PD according to SCID-II. AN patients of the binge-purging type showed higher prevalences of PD and higher dimensional scores than the other eating disorder groups. Moreover, our findings indicate that age and axis-I-comorbidities are associated with the development of PD. Significant differences in the occurrence of PD in the three eating disorder groups were found. Patients of the AN binge-purging type are more often affected than restricting AN or BN patients are. This, and also the influence of age and axis-I-comorbidities, should be taken into account in the treatment of patients with eating disorders.

  10. Clinical evaluation of autistic symptoms in women with anorexia nervosa.

    Science.gov (United States)

    Westwood, Heather; Mandy, William; Tchanturia, Kate

    2017-01-01

    Despite a suggested link between anorexia nervosa (AN) and autism spectrum disorder (ASD), previous studies have used self-report or diagnostic criteria to assess for ASD in AN populations, rather than direct observation of symptom characteristic of ASD. The aim of this study was to use a standardised, clinical assessment of ASD, the Autism Diagnostic Observation Schedule, 2nd Edition (ADOS-2), to investigate the presence of autistic symptoms in a cross-sectional sample of women with AN. Sixty women were recruited from inpatient or day-patient specialist eating disorder services. Each participant underwent the ADOS-2 assessment and completed a set of self-report questionnaires assessing eating disorder pathology and other psychiatric symptoms. IQ was also assessed. Fourteen women (23.3%) scored above clinical cutoff for ASD on the ADOS-2. Only eight of these women displayed repetitive or restrictive behaviours, while all 14 had difficulties with social affect. Elevated ASD symptoms were associated with increased alexithymia and obsessive-compulsive symptoms, but not specific eating disorder pathology. ASD symptoms are over-represented in women with severe AN and appear to be associated with other psychiatric symptoms, which warrant further investigation and consideration in treatment.

  11. First do no harm: iatrogenic maintaining factors in anorexia nervosa.

    Science.gov (United States)

    Treasure, Janet; Crane, Anna; McKnight, Rebecca; Buchanan, Emmakate; Wolfe, Melissa

    2011-01-01

    The aim of this paper is to reflect on the way that we as clinicians may play an inadvertent role in perpetuating eating disordered behaviour. This is considered within the theoretical framework of Schmidt and Treasures' maintenance model of anorexia nervosa (AN). The model includes four main domains; interpersonal factors, pro-AN beliefs, emotional style and thinking style. Interpersonal reactions are of particular relevance as clinicians (as with family members) may react with high expressed emotion and unknowingly encourage eating disorder behaviours to continue. Hostility in the form of coercive refeeding in either a hospital or outpatient setting may strengthen conditioned food avoidance and pessimism may hamper motivation to change. Negative schema common to eating disorders, for example low self-esteem, perfectionism and striving for social value may augment existing or initiate new eating disorder behaviour. Services can become a reinforcing influence by providing an overly protective, palliating environment which ensures safety, security and acceptance whilst reducing loneliness and isolation. This stifles the need for an individual to develop their own sense of responsibility, autonomy and independence allowing avoidance to dominate. Furthermore, the highly structured environment of inpatient care supports the rigid attention to detail and inflexibility that is characteristic of people with eating disorders, and allows these negative behaviours to thrive. Careful planning of service provision, reflective practice, supervision and regular team feedback is essential to prevent iatrogenic harm. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

  12. Increased reverse T/sub 3/ concentration in patients with anorexia nervosa

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    Baranowska, B.; Kaniewski, M.; Zgliczynski, S. (Centrum Medyczne Ksztalcenia Podyplomowego, Warsaw (Poland))

    1980-01-01

    In 20 female patients with anorexia nervosa, aging 16 - 26 years, the thyroid function was estimated by +- determining TSH secretion in response to TRH, and serum thyroxine (T/sub 4/), 3,5,3'L-triiodothyronine (T/sub 3/) and 3,3',5'L-triiodothyronine (reverse T/sub 3/) concentrations. 14 healthy women of the same age were included into the control group. If compared with control group, a marked supression of TRH stimulated TSH secretion and a lowering of serum T/sub 3/ concentration was found in patients with anorexia nervosa. On the other hand, serum reverse T/sub 3/ concentration was markedly higher in patients with anorexia nervosa than in control ones. Gain of body weight leads to normalization of thyroid hormones level in the serum. Obtained results show for peripheral mechanism of described hormonal disorders.

  13. What does uncertainty mean to women with anorexia nervosa? An interpretative phenomenological analysis.

    Science.gov (United States)

    Sternheim, Lot; Konstantellou, Anna; Startup, Helen; Schmidt, Ulrike

    2011-01-01

    The objective of this study was to explore the construct of intolerance of uncertainty in patients with anorexia nervosa through focus groups. Nine women with anorexia nervosa participated in three focus groups in an in-patient, rehabilitation and day care setting. Focus groups probed participants' experiences of uncertainty and the meaning to them of uncertainty on a physical, behavioural, cognitive and emotional level. Data were analysed using Interpretative Phenomenological Analysis (IPA). Patients experienced uncertainty as stressful and wanted to avoid this at all costs. Prominent sources of uncertainty were fear of negative evaluation by others and feelings of being imperfect. Uncertain situations led participants to feel anxious and 'out of control', resulting in a strong desire for control which manifested in extreme organising and planning. Results suggest that treatment strategies aimed at increasing tolerance of uncertainty in people with anorexia nervosa could be beneficial. Copyright © 2010 John Wiley & Sons, Ltd and Eating Disorders Association.

  14. Inpatient cognitive behaviour therapy for adolescents with anorexia nervosa: immediate and longer-term effects

    Directory of Open Access Journals (Sweden)

    Riccardo eDalle Grave

    2014-02-01

    Full Text Available Introduction: Inpatient treatment for anorexia nervosa is often successful in restoring body weight, but a high percentage of patients relapse following discharge. The aim of the present study was to establish the immediate and longer-term effects of a novel inpatient program for adolescents that was designed to produce enduring change. Method: Twenty-seven consecutive patients with severe anorexia nervosa were admitted to a 20-week inpatient treatment program based upon enhanced cognitive behaviour therapy (CBT-E. The patients were assessed before and after hospitalization, and six and 12 months later. Results: Twenty-six patients (96% completed the program. In these patients there was a substantial improvement in weight, eating disorder features and general psychopathology that was well maintained at 12-month follow-up. Conclusions: These findings suggest that inpatient CBT-E is a promising approach to the treatment of adolescents with severe anorexia nervosa.

  15. Cancer Incidence among Patients with Anorexia Nervosa from Sweden, Denmark and Finland

    Science.gov (United States)

    Mellemkjaer, Lene; Papadopoulos, Fotios C.; Pukkala, Eero; Ekbom, Anders; Gissler, Mika; Christensen, Jane; Olsen, Jørgen H.

    2015-01-01

    A diet with restricted energy content reduces the occurrence of cancer in animal experiments. It is not known if the underlying mechanism also exists in human beings. To determine whether cancer incidence is reduced among patients with anorexia nervosa who tend to have a low intake of energy, we carried out a retrospective cohort study of 22 654 women and 1678 men diagnosed with anorexia nervosa at ages 10-50 years during 1968-2010 according to National Hospital Registers in Sweden, Denmark and Finland. The comparison group consisted of randomly selected persons from population registers who were similar to the anorexia nervosa patients in respect to sex, year of birth and place of residence. Patients and population comparisons were followed for cancer by linkage to Cancer Registries. Incidence rate ratios (IRR) were estimated using Poisson models. In total, 366 cases of cancer (excluding non-melanoma skin cancer) were seen among women with anorexia nervosa, and the IRR for all cancer sites was 0.97 (95% CI = 0.87-1.08) adjusted for age, parity and age at first child. There were 76 breast cancers corresponding to an adjusted IRR of 0.61 (95% CI = 0.49-0.77). Significantly increased IRRs were observed for esophageal, lung, and liver cancer. Among men with anorexia nervosa, there were 23 cases of cancer (age-adjusted IRR = 1.08; 95% CI = 0.71-1.66). There seems to be no general reduction in cancer occurrence among patients with anorexia nervosa, giving little support to the energy restriction hypothesis. PMID:26000630

  16. Cancer Incidence among Patients with Anorexia Nervosa from Sweden, Denmark and Finland.

    Directory of Open Access Journals (Sweden)

    Lene Mellemkjaer

    Full Text Available A diet with restricted energy content reduces the occurrence of cancer in animal experiments. It is not known if the underlying mechanism also exists in human beings. To determine whether cancer incidence is reduced among patients with anorexia nervosa who tend to have a low intake of energy, we carried out a retrospective cohort study of 22 654 women and 1678 men diagnosed with anorexia nervosa at ages 10-50 years during 1968-2010 according to National Hospital Registers in Sweden, Denmark and Finland. The comparison group consisted of randomly selected persons from population registers who were similar to the anorexia nervosa patients in respect to sex, year of birth and place of residence. Patients and population comparisons were followed for cancer by linkage to Cancer Registries. Incidence rate ratios (IRR were estimated using Poisson models. In total, 366 cases of cancer (excluding non-melanoma skin cancer were seen among women with anorexia nervosa, and the IRR for all cancer sites was 0.97 (95% CI = 0.87-1.08 adjusted for age, parity and age at first child. There were 76 breast cancers corresponding to an adjusted IRR of 0.61 (95% CI = 0.49-0.77. Significantly increased IRRs were observed for esophageal, lung, and liver cancer. Among men with anorexia nervosa, there were 23 cases of cancer (age-adjusted IRR = 1.08; 95% CI = 0.71-1.66. There seems to be no general reduction in cancer occurrence among patients with anorexia nervosa, giving little support to the energy restriction hypothesis.

  17. Cancer Incidence among Patients with Anorexia Nervosa from Sweden, Denmark and Finland.

    Science.gov (United States)

    Mellemkjaer, Lene; Papadopoulos, Fotios C; Pukkala, Eero; Ekbom, Anders; Gissler, Mika; Christensen, Jane; Olsen, Jørgen H

    2015-01-01

    A diet with restricted energy content reduces the occurrence of cancer in animal experiments. It is not known if the underlying mechanism also exists in human beings. To determine whether cancer incidence is reduced among patients with anorexia nervosa who tend to have a low intake of energy, we carried out a retrospective cohort study of 22 654 women and 1678 men diagnosed with anorexia nervosa at ages 10-50 years during 1968-2010 according to National Hospital Registers in Sweden, Denmark and Finland. The comparison group consisted of randomly selected persons from population registers who were similar to the anorexia nervosa patients in respect to sex, year of birth and place of residence. Patients and population comparisons were followed for cancer by linkage to Cancer Registries. Incidence rate ratios (IRR) were estimated using Poisson models. In total, 366 cases of cancer (excluding non-melanoma skin cancer) were seen among women with anorexia nervosa, and the IRR for all cancer sites was 0.97 (95% CI = 0.87-1.08) adjusted for age, parity and age at first child. There were 76 breast cancers corresponding to an adjusted IRR of 0.61 (95% CI = 0.49-0.77). Significantly increased IRRs were observed for esophageal, lung, and liver cancer. Among men with anorexia nervosa, there were 23 cases of cancer (age-adjusted IRR = 1.08; 95% CI = 0.71-1.66). There seems to be no general reduction in cancer occurrence among patients with anorexia nervosa, giving little support to the energy restriction hypothesis.

  18. An examination of autism spectrum traits in adolescents with anorexia nervosa and their parents.

    Science.gov (United States)

    Rhind, Charlotte; Bonfioli, Elena; Hibbs, Rebecca; Goddard, Elizabeth; Macdonald, Pamela; Gowers, Simon; Schmidt, Ulrike; Tchanturia, Kate; Micali, Nadia; Treasure, Janet

    2014-01-01

    There may be a link between anorexia nervosa and autism spectrum disorders. The aims of this study were to examine whether adolescents with anorexia nervosa have autism spectrum and/or obsessive-compulsive traits, how many would meet diagnostic criteria for autism spectrum disorder, and whether these traits are shared by parents. A total of 150 adolescents receiving outpatient treatment for anorexia nervosa or subthreshold anorexia nervosa and their parents completed the autism spectrum disorder and eating disorder sections of the Development and Well-being Assessment. Patients also completed the Children Yale-Brown Obsessive-Compulsive Scale and other measures of psychiatric morbidity, and parents completed the short Autism Quotient and Obsessive-Compulsive Inventory Revised. Adolescents with anorexia nervosa had a below average social aptitude (19% below cut-off) and high levels of peer relationship problems (39% above cut-off) and obsessive-compulsive symptoms (56% above cut-off). Six cases (4%, all females) were assigned a possible (n = 5) or definite (n = 1) diagnosis of autism spectrum disorder. Parental levels of autism spectrum and obsessive-compulsive traits were within the normal range. This study suggests that adolescents with anorexia nervosa have elevated levels of autism spectrum traits, obsessive-compulsive symptoms, and a small proportion fulfil diagnostic criteria for a probable autism spectrum disorder. These traits did not appear to be familial. This comorbidity has been associated with a poorer prognosis. Therefore, adaptation of treatment for this subgroup may be warranted. Controlled-trials.com: ISRCTN83003225. Registered on 29 September 2011.

  19. Resistance training enhances muscular performance in patients with anorexia nervosa: A randomized controlled trial

    OpenAIRE

    Fernández del Valle, María; Larumbe Zabala, Eneko; Villaseñor Montarroso, Ángel; Cardona González, Claudia Andrea; Díez Vega, Ignacio; López Mojares, Luis Miguel; Pérez Ruiz, Margarita

    2014-01-01

    OBJECTIVE: Low-intensity exercise applied in anorexia nervosa patients has been shown to have a harmless effect on body composition and to effect short-term improvements in muscular strength and agility. The aim of this study was to determine the effects of a high-intensity resistance training program designed for adolescents to improve strength and agility in anorexia nervosa restricting-type patients (AN-R). METHODS: From a total of 36 female patients with AN-R, one group (interven...

  20. [Prevention and Treatment of Eating Disorders: The Health Care Network Anorexia and Bulimia nervosa].

    Science.gov (United States)

    Weigel, Angelika; Gumz, Antje; Kästner, Denise; Romer, Georg; Wegscheider, Karl; Löwe, Bernd

    2015-07-01

    The "Health care network anorexia and bulimia nervosa", a subproject of psychenet - the Hamburg network for mental health - aims to decrease the incidence of eating disorders as well as the risk for chronic illness courses. One focal project, therefore, evaluates a school-based prevention manual in a randomized controlled trial. The other one examines the impact of a systemic public health intervention on early treatment initiation in anorexia nervosa. The present article provides an overview about study design and interventions in both focal projects as well as preliminary results. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Adolescents with a diagnosis of anorexia nervosa: parents' experience of recognition and deciding to seek help.

    Science.gov (United States)

    Thomson, Samuel; Marriott, Michael; Telford, Katherine; Law, Hou; McLaughlin, Jo; Sayal, Kapil

    2014-01-01

    Adolescents with anorexia nervosa rarely present themselves as having a problem and are usually reliant on parents to recognise the problem and facilitate help-seeking. This study aimed to investigate parents' experiences of recognising that their child had an eating problem and deciding to seek help. A qualitative study with interpretative phenomenological analysis applied to semi-structured interviews with eight parents of adolescents with a diagnosis of anorexia nervosa. Parents commonly attributed early signs of anorexia nervosa to normal adolescent development and they expected weight loss to be short-lived. As parents' suspicions grew, close monitoring exposing their child's secretive attempts to lose weight and the use of internet searches aided parental recognition of the problem. They avoided using the term anorexia as it made the problem seem 'real'. Following serial unsuccessful attempts to effect change, parental fear for their child's life triggered a desire for professional help. Parents require early advice and support to confirm their suspicions that their child might have anorexia nervosa. Since parents commonly approach the internet for guidance, improving awareness of useful and accurate websites could reduce delays in help-seeking.

  2. Ghrelin: Central and Peripheral Implications in Anorexia Nervosa

    Science.gov (United States)

    Méquinion, Mathieu; Langlet, Fanny; Zgheib, Sara; Dickson, Suzanne; Dehouck, Bénédicte; Chauveau, Christophe; Viltart, Odile

    2012-01-01

    Increasing clinical and therapeutic interest in the neurobiology of eating disorders reflects their dramatic impact on health. Chronic food restriction resulting in severe weight loss is a major symptom described in restrictive anorexia nervosa (AN) patients, and they also suffer from metabolic disturbances, infertility, osteopenia, and osteoporosis. Restrictive AN, mostly observed in young women, is the third largest cause of chronic illness in teenagers of industrialized countries. From a neurobiological perspective, AN-linked behaviors can be considered an adaptation that permits the endurance of reduced energy supply, involving central and/or peripheral reprograming. The severe weight loss observed in AN patients is accompanied by significant changes in hormones involved in energy balance, feeding behavior, and bone formation, all of which can be replicated in animals models. Increasing evidence suggests that AN could be an addictive behavior disorder, potentially linking defects in the reward mechanism with suppressed food intake, heightened physical activity, and mood disorder. Surprisingly, the plasma levels of ghrelin, an orexigenic hormone that drives food-motivated behavior, are increased. This increase in plasma ghrelin levels seems paradoxical in light of the restrained eating adopted by AN patients, and may rather result from an adaptation to the disease. The aim of this review is to describe the role played by ghrelin in AN focusing on its central vs. peripheral actions. In AN patients and in rodent AN models, chronic food restriction induces profound alterations in the « ghrelin » signaling that leads to the development of inappropriate behaviors like hyperactivity or addiction to food starvation and therefore a greater depletion in energy reserves. The question of a transient insensitivity to ghrelin and/or a potential metabolic reprograming is discussed in regard of new clinical treatments currently investigated. PMID:23549309

  3. Cholecystokinin revisited: CCK and the hunger trap in anorexia nervosa.

    Directory of Open Access Journals (Sweden)

    Ulrich Cuntz

    Full Text Available OBJECTIVE: Despite a number of studies in the past decades, the role of Cholecystokinin (CCK in anorexia nervosa (AN has remained uncertain. In this study a highly specific assay for the biologically active part of CCK was used in patients with bulimic as well as with the restricting type of AN who were followed over the course of weight gain. METHODS: Ten patients with restricting and 13 with bulimic AN were investigated upon admission (T0, after a weight gain of at least 2 kg on two consecutive weighting dates (T1, and during the last week before discharge (T2 from inpatient treatment in a specialized clinic. Blood samples were drawn under fasting conditions and 20 and 60 minutes following a standard meal (250 kcal. Data were compared to those of eight controls matched for sex and age. Gastrointestinal complaints of patients were measured by a questionnaire at each of the follow-up time points. RESULTS: At admission, AN patients exhibited CCK-levels similar to controls both prior to and after a test meal. Pre and post-meal CCK levels increased significantly after an initial weight gain but decreased again with further weight improvement. CCK release was somewhat lower in bulimic than in restricting type AN but both subgroups showed a similar profile. There was no significant association of CCK release to either initial weight or BMI, or their changes, but CCK levels at admission predicted gastrointestinal symptom improvement during therapy. CONCLUSIONS: Normal CCK profiles in AN at admission indicates hormonal responses adapted to low food intake while change of eating habits and weight gain results in initially increased CCK release (counteracting the attempts to alter eating behavior that returns towards normal levels with continuous therapy.

  4. Osteopenia in anorexia nervosa: specific mechanisms of bone loss.

    Science.gov (United States)

    Lennkh, C; de Zwaan, M; Bailer, U; Strnad, A; Nagy, C; el-Giamal, N; Wiesnagrotzki, S; Vytiska, E; Huber, J; Kasper, S

    1999-01-01

    Osteopenia is a well recognized medical complication of anorexia nervosa (AN). The mechanism of bone loss is not fully understood and there is uncertainty about its management. New markers of bone turnover have been developed. C-terminal type 1 propeptide (PICP) is a measure of bone formation and urinary pyridinolines such as deoxypyridinoline (DPYRX) and serum carboxyterminal crosslinked telopeptide (ICTP) are markers of bone resorption. The aim of this study was to examine these bone markers in patients with AN. Twenty female patients with AN and 12 healthy controls were included in the study. Bone mineral density (BMD) of AN patients was measured by dual energy X-ray absorptiometry (DEXA). Lumbar bone density was significantly reduced in the AN group compared to standardised values of thirty year old adults (t-score 83.2%, S.D. 12.1). Femoral neck bone density showed an even greater reduction (t-score 79.4%, S.D. 13.5). We found a significant negative correlation between femoral BMD and the duration of the illness. Femoral BMD correlated significantly with minimal body weight (r(16) = 0.504, p = 0.033). The markers of bone resorption were significantly higher in the patients with AN compared to the values of the control group (ICTP t(30) = -2.15, p = 0.04, DPYRX t(25) = -2.26, p = 0.033), whereas the markers of bone formation did not differ significantly between the groups. AN appears to be a low turn over state associated with increased bone resorption without concomitant bone formation. This pattern differs from osteopenia in menopausal women and should, therefore, lead to the development of specific therapeutic strategies in AN associated osteopenia. Hormone replacement therapy as well as calcium and vitamine D-supplementation are so far discussed controversially. Long-term treatment studies are warranted.

  5. Latent profile analysis of eating episodes in anorexia nervosa.

    Science.gov (United States)

    Goldschmidt, Andrea B; Wonderlich, Stephen A; Crosby, Ross D; Cao, Li; Engel, Scott G; Lavender, Jason M; Mitchell, James E; Crow, Scott J; Peterson, Carol B; Le Grange, Daniel

    2014-06-01

    Despite being characterized primarily by disturbances in eating behavior, relatively little is known about specific eating behaviors in anorexia nervosa (AN) and how they relate to different emotional, behavioral, and environmental features. Women with AN (n = 118) completed a 2-week ecological momentary assessment (EMA) protocol during which they reported on daily eating- and mood-related patterns. Latent profile analysis was used to identify classes of eating episodes based on the presence or absence of the following indicators: loss of control; overeating; eating by oneself; food avoidance; and dietary restraint. The best-fitting model supported a 5-class solution: avoidant eating; solitary eating; binge eating; restrictive eating; and loss of control eating. The loss of control and binge eating classes were characterized by high levels of concurrent negative affect and a greater likelihood of engaging in compensatory behaviors. The restrictive eating class was associated with the greatest number of concurrently-reported stressful events, while the avoidant and solitary eating episode classes were characterized by relatively few accompanying stressful events. Body checking was least likely to occur in conjunction with restrictive eating behaviors. Results support the presence of discrete types of eating episodes in AN that are associated with varying degrees of negative affect, stress, and behavioral features of eating disorders. Loss of control and dietary restriction may serve distinct functional purposes in AN, as highlighted by their differing associations with negative affect and stress. Clinical interventions for AN may benefit from targeting functional aspects of eating behavior among those with the disorder. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. A genome-wide association study of anorexia nervosa

    Science.gov (United States)

    Boraska, Vesna; Franklin, Christopher S; Floyd, James AB; Thornton, Laura M; Huckins, Laura M; Southam, Lorraine; Rayner, N William; Tachmazidou, Ioanna; Klump, Kelly L; Treasure, Janet; Lewis, Cathryn M; Schmidt, Ulrike; Tozzi, Federica; Kiezebrink, Kirsty; Hebebrand, Johannes; Gorwood, Philip; Adan, Roger AH; Kas, Martien JH; Favaro, Angela; Santonastaso, Paolo; Fernández-Aranda, Fernando; Gratacos, Monica; Rybakowski, Filip; Dmitrzak-Weglarz, Monika; Kaprio, Jaakko; Keski-Rahkonen, Anna; Raevuori, Anu; Van Furth, Eric F; Landt, Margarita CT Slof-Op t; Hudson, James I; Reichborn-Kjennerud, Ted; Knudsen, Gun Peggy S; Monteleone, Palmiero; Kaplan, Allan S; Karwautz, Andreas; Hakonarson, Hakon; Berrettini, Wade H; Guo, Yiran; Li, Dong; Schork, Nicholas J.; Komaki, Gen; Ando, Tetsuya; Inoko, Hidetoshi; Esko, Tõnu; Fischer, Krista; Männik, Katrin; Metspalu, Andres; Baker, Jessica H; Cone, Roger D; Dackor, Jennifer; DeSocio, Janiece E; Hilliard, Christopher E; O'Toole, Julie K; Pantel, Jacques; Szatkiewicz, Jin P; Taico, Chrysecolla; Zerwas, Stephanie; Trace, Sara E; Davis, Oliver SP; Helder, Sietske; Bühren, Katharina; Burghardt, Roland; de Zwaan, Martina; Egberts, Karin; Ehrlich, Stefan; Herpertz-Dahlmann, Beate; Herzog, Wolfgang; Imgart, Hartmut; Scherag, André; Scherag, Susann; Zipfel, Stephan; Boni, Claudette; Ramoz, Nicolas; Versini, Audrey; Brandys, Marek K; Danner, Unna N; de Kovel, Carolien; Hendriks, Judith; Koeleman, Bobby PC; Ophoff, Roel A; Strengman, Eric; van Elburg, Annemarie A; Bruson, Alice; Clementi, Maurizio; Degortes, Daniela; Forzan, Monica; Tenconi, Elena; Docampo, Elisa; Escaramís, Geòrgia; Jiménez-Murcia, Susana; Lissowska, Jolanta; Rajewski, Andrzej; Szeszenia-Dabrowska, Neonila; Slopien, Agnieszka; Hauser, Joanna; Karhunen, Leila; Meulenbelt, Ingrid; Slagboom, P Eline; Tortorella, Alfonso; Maj, Mario; Dedoussis, George; Dikeos, Dimitris; Gonidakis, Fragiskos; Tziouvas, Konstantinos; Tsitsika, Artemis; Papezova, Hana; Slachtova, Lenka; Martaskova, Debora; Kennedy, James L.; Levitan, Robert D.; Yilmaz, Zeynep; Huemer, Julia; Koubek, Doris; Merl, Elisabeth; Wagner, Gudrun; Lichtenstein, Paul; Breen, Gerome; Cohen-Woods, Sarah; Farmer, Anne; McGuffin, Peter; Cichon, Sven; Giegling, Ina; Herms, Stefan; Rujescu, Dan; Schreiber, Stefan; Wichmann, H-Erich; Dina, Christian; Sladek, Rob; Gambaro, Giovanni; Soranzo, Nicole; Julia, Antonio; Marsal, Sara; Rabionet, Raquel; Gaborieau, Valerie; Dick, Danielle M; Palotie, Aarno; Ripatti, Samuli; Widén, Elisabeth; Andreassen, Ole A; Espeseth, Thomas; Lundervold, Astri; Reinvang, Ivar; Steen, Vidar M; Le Hellard, Stephanie; Mattingsdal, Morten; Ntalla, Ioanna; Bencko, Vladimir; Foretova, Lenka; Janout, Vladimir; Navratilova, Marie; Gallinger, Steven; Pinto, Dalila; Scherer, Stephen; Aschauer, Harald; Carlberg, Laura; Schosser, Alexandra; Alfredsson, Lars; Ding, Bo; Klareskog, Lars; Padyukov, Leonid; Finan, Chris; Kalsi, Gursharan; Roberts, Marion; Logan, Darren W; Peltonen, Leena; Ritchie, Graham RS; Barrett, Jeffrey C; Estivill, Xavier; Hinney, Anke; Sullivan, Patrick F; Collier, David A; Zeggini, Eleftheria; Bulik, Cynthia M

    2015-01-01

    Anorexia nervosa (AN) is a complex and heritable eating disorder characterized by dangerously low body weight. Neither candidate gene studies nor an initial genome wide association study (GWAS) have yielded significant and replicated results. We performed a GWAS in 2,907 cases with AN from 14 countries (15 sites) and 14,860 ancestrally matched controls as part of the Genetic Consortium for AN (GCAN) and the Wellcome Trust Case Control Consortium 3 (WTCCC3). Individual association analyses were conducted in each stratum and meta-analyzed across all 15 discovery datasets. Seventy-six (72 independent) SNPs were taken forward for in silico (two datasets) or de novo (13 datasets) replication genotyping in 2,677 independent AN cases and 8,629 European ancestry controls along with 458 AN cases and 421 controls from Japan. The final global meta-analysis across discovery and replication datasets comprised 5,551 AN cases and 21,080 controls. AN subtype analyses (1,606 AN restricting; 1,445 AN binge-purge) were performed. No findings reached genome-wide significance. Two intronic variants were suggestively associated: rs9839776 (P=3.01×10-7) in SOX2OT and rs17030795 (P=5.84×10-6) in PPP3CA. Two additional signals were specific to Europeans: rs1523921 (P=5.76×10-6) between CUL3 and FAM124B and rs1886797 (P=8.05×10-6) near SPATA13. Comparing discovery to replication results, 76% of the effects were in the same direction, an observation highly unlikely to be due to chance (P=4×10-6), strongly suggesting that true findings exist but that our sample, the largest yet reported, was underpowered for their detection. The accrual of large genotyped AN case-control samples should be an immediate priority for the field. PMID:24514567

  7. Anorexia nervosa and Wernicke-Korsakoff syndrome: a case report.

    Science.gov (United States)

    Saad, Laura; Silva, Luiz Fal; Banzato, Claudio Em; Dantas, Clarissa R; Garcia, Celso

    2010-07-20

    anorexia nervosa who also misuse alcohol is probably at a particular risk of developing Wernicke-Korsakoff syndrome. The present case report highlights this relevant issue.

  8. Atypical antipsychotics as augmentation therapy in anorexia nervosa.

    Directory of Open Access Journals (Sweden)

    Enrica Marzola

    Full Text Available Anorexia nervosa (AN is a life-threatening and difficult to treat mental illness with the highest mortality rates of any psychiatric disorder. We aimed to garner preliminary data on the real-world use of olanzapine and aripiprazole as augmentation agents of Selective Serotonin Reuptake Inhibitors (SSRIs in adult inpatients affected by AN. We retrospectively evaluated the clinical charts of patients who were hospitalized between 2012 and 2014. Patients were evaluated upon admission and discharge. We investigated eating symptomatology, and both general and eating psychopathology using: Hamilton Rating Scale for Anxiety, Hamilton Rating Scale for Depression, and Yale-Brown-Cornell Eating Disorders Scale. The charts of 75 patients were included in this study. The sample resulted equally distributed among those receiving SSRIs and either aripiprazole or olanzapine in addition to SSRIs. Notwithstanding a few baseline clinical differences, upon discharge all groups were significantly improved on all measures. Interestingly, aripiprazole showed the greatest effectiveness in reducing eating-related preoccupations and rituals with a large effect size. The body of evidence on medication management in AN is in dismal condition. Augmentation therapy is a well-established approach to a variety of mental disorders and it is often used in every-day clinical practice with patients affected by AN as well. Nevertheless, to date very little data is available on this topic. Results from our sample yielded promising results on the effectiveness of aripiprazole augmentation in reducing eating-related obsessions and compulsions. Randomized controlled trials are warranted to confirm these encouraging findings.

  9. Ghrelin: Central and Peripheral Implications in Anorexia Nervosa

    Directory of Open Access Journals (Sweden)

    Mathieu eMéquinion

    2013-02-01

    Full Text Available Food intake and associated disorders are gaining large emphasis in our societies due to their dramatic physiological and psychological consequences on health. Chronic food restriction is a major symptom described in restrictive anorexia nervosa (AN patients. This disease, mostly observed in young women is the third cause of chronic illness in teenagers. It leads to central and/or peripheral reprogramming that permits the organism to endure the reduced energy supplies. These drastic conditions induce severe weight loss, metabolic disturbances, infertility, osteopenia and osteoporosis. Moreover, increasing number of arguments consider AN as an addictive behaviour to food deprivation or weight loss or physical activity, usually associated with mood disorders. This suggests a potential alteration of the central reward system. Significant changes in hormones involved in energy metabolism, regulation of feeding behaviours and bone formation are described in AN patients, but also in animal models presenting a strong face validity. Surprisingly, the plasma levels of ghrelin, an orexigenic hormone, are increased. This hormone acts centrally to modulate food intake, but also peripherally mainly to maintain blood glucose and to regulate gastric motility. Such increase in plasma ghrelin levels seems paradoxical in light of the restrained eating adopted by these AN patients, but adaptive. The aim of this review is to describe the role played by ghrelin in AN focusing on its central vs peripheral action. The chronic food restriction induces both in AN patients and in rodent models a profound alteration in the « ghrelin » signal integration that lead to the development of inappropriate behaviours like hyperactivity or addiction to food starvation and therefore a greater depletion in energy reserves. The question of a transient insensitivity to ghrelin and/or a potential metabolic reprogramming is discussed in regard of new clinical treatments currently

  10. Latent profile analysis of eating episodes in anorexia nervosa

    Science.gov (United States)

    Goldschmidt, Andrea B.; Wonderlich, Stephen A.; Crosby, Ross D.; Cao, Li; Engel, Scott G.; Lavender, Jason M.; Mitchell, James E.; Crow, Scott J.; Peterson, Carol B.; Le Grange, Daniel

    2014-01-01

    Background Despite being characterized primarily by disturbances in eating behavior, relatively little is known about specific eating behaviors in anorexia nervosa (AN) and how they relate to different emotional, behavioral, and environmental features. Methods Women with AN (n=118) completed a 2-week ecological momentary assessment (EMA) protocol during which they reported on daily eating- and mood-related patterns. Latent profile analysis was used to identify classes of eating episodes based on the presence or absence of the following indicators: loss of control; overeating; eating by oneself; food avoidance; and dietary restraint. Results The best-fitting model supported a 5-class solution: avoidant eating; solitary eating; binge eating; restrictive eating; and loss of control eating. The loss of control and binge eating classes were characterized by high levels of concurrent negative affect and a greater likelihood of engaging in compensatory behaviors. The restrictive eating class was associated with the greatest number of concurrently-reported stressful events, while the avoidant and solitary eating episode classes were characterized by relatively few accompanying stressful events. Body checking was least likely to occur in conjunction with restrictive eating behaviors. Conclusions Results support the presence of discrete types of eating episodes in AN that are associated with varying degrees of negative affect, stress, and behavioral features of eating disorders. Loss of control and dietary restriction may serve distinct functional purposes in AN, as highlighted by their differing associations with negative affect and stress. Clinical interventions for AN may benefit from targeting functional aspects of eating behavior among those with the disorder. PMID:24630466

  11. Physical and Psychological Morbidity in Adolescents With Atypical Anorexia Nervosa.

    Science.gov (United States)

    Sawyer, Susan M; Whitelaw, Melissa; Le Grange, Daniel; Yeo, Michele; Hughes, Elizabeth K

    2016-04-01

    Adolescents with atypical anorexia nervosa (AN) have lost significant weight but are not underweight. This study aimed to describe the physical and psychological morbidity of adolescents diagnosed with atypical AN, and to compare them with underweight adolescents with AN. All first presentations of atypical AN (n = 42) and full-threshold AN (n = 118) to a specialist pediatric eating disorder program between July 2010 and June 2014 were examined. Diagnosis was assessed by using the Eating Disorder Examination and anthropometric measurement. Psychological morbidity measures included eating and weight concerns, bingeing, purging, compulsive exercise, and psychiatric comorbidity. Compared with AN, more adolescents with atypical AN were premorbidly overweight or obese (71% vs 12%). They had lost more weight (17.6 kg vs 11.0 kg) over a longer period (13.3 vs 10.2 months). There was no significant difference in the frequency of bradycardia (24% vs 33%;) or orthostatic instability (43% vs 38%). We found no evidence of a difference in frequency of psychiatric comorbidities (38% vs 45%) or suicidal ideation (43% vs 39%). Distress related to eating and body image was more severe in atypical AN. Atypical AN considerably affects physical and psychological functioning, despite adolescents presenting within or above the normal weight range. There was little evidence that the morbidity of adolescents with atypical AN was any less severe than that of adolescents with full-threshold AN. The findings support the need for vigilance around weight loss in adolescents, regardless of body size. Copyright © 2016 by the American Academy of Pediatrics.

  12. Family functioning in two treatments for adolescent anorexia nervosa.

    Science.gov (United States)

    Ciao, Anna C; Accurso, Erin C; Fitzsimmons-Craft, Ellen E; Lock, James; Le Grange, Daniel

    2015-01-01

    Family functioning impairment is widely reported in the eating disorders literature, yet few studies have examined the role of family functioning in treatment for adolescent anorexia nervosa (AN). This study examined family functioning in two treatments for adolescent AN from multiple family members' perspectives. Participants were 121 adolescents with AN ages 12-18 from a randomized-controlled trial comparing family-based treatment (FBT) to individual adolescent-focused therapy (AFT). Multiple clinical characteristics were assessed at baseline. Family functioning from the perspective of the adolescent and both parents was assessed at baseline and after 1 year of treatment. Full remission from AN was defined as achieving both weight restoration and normalized eating disorder psychopathology. In general, families dealing with AN reported some baseline impairment in family functioning, but average ratings were only slightly elevated compared to published impaired functioning cutoffs. Adolescents' perspectives on family functioning were the most impaired and were generally associated with poorer psychosocial functioning and greater clinical severity. Regardless of initial level of family functioning, improvements in several family functioning domains were uniquely related to full remission at the end of treatment in both FBT and AFT. However, FBT had a more positive impact on several specific aspects of family functioning compared to AFT. Families seeking treatment for adolescent AN report some difficulties in family functioning, with adolescents reporting the greatest impairment. Although FBT may be effective in improving some specific aspects of family dynamics, remission from AN was associated with improved family dynamics, regardless of treatment type. © 2014 Wiley Periodicals, Inc.

  13. Differentiating constitutional thinness from anorexia nervosa in DSM 5 era.

    Science.gov (United States)

    Estour, Bruno; Marouani, Nesrine; Sigaud, Torrance; Lang, François; Fakra, Eric; Ling, Yiin; Diamondé, Aurélie; Minnion, James S; Galusca, Bogdan; Germain, Natacha

    2017-10-01

    Constitutional thinness (CT) is an underweight state characterized by normal menstruations and no change in feeding behaviour. Thinness is the only resemblance between Anorexia Nervosa (AN) and CT. Removal of amenorrhea from the new DSM 5 definition of AN might result in misdiagnosis between these two populations. The objective of this study was to compare CT, AN and Control subjects in terms of biological, anthropometric, and psychological markers in order to better distinguish AN from CT subjects. Body composition, nutritional markers, pituitary hormones, bone markers and psychological scores were evaluated in three groups of young women: fifty-six CT, forty restrictive-type AN and fifty-four Control subjects. For every marker, a receiver Operator Characteristics (ROC) curve was calculated to evaluate the accuracy of differentiation between AN and CT groups. For most studied parameters, CT subjects were similar to Controls but dramatically different from AN subjects. DEBQ Restrained Eating subscale score was identified by ROC data analysis as the only psychological parameter tested to successfully differentiate AN from CT. Free-T3 and Leptin were shown to be powerful markers to differentiate AN and CT populations as they were highly specific and sensitive ones. The exclusive use of psychological testing criteria is not always sufficient to differentiate AN and CT patients. Minimally, additional testing of Free T3 levels, which is cheap and widely accessible for general practitioners, should be completed to avoid misdiagnosis which could result in the implementation of ineffective treatment plans and social stigmatization for CT women. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Brain connectome modularity in weight-restored anorexia nervosa and body dysmorphic disorder

    Science.gov (United States)

    Zhang, A; Leow, A; Zhan, L; GadElkarim, J; Moody, T; Khalsa, S; Strober, M; Feusner, JD

    2017-01-01

    Background Anorexia nervosa (AN) and body dysmorphic disorder (BDD) frequently co-occur, and have several overlapping phenomenological features. Little is known about their shared neurobiology. Aims To compare modular organization of brain structural connectivity. Methods We acquired diffusion-weighted magnetic resonance imaging data on unmedicated individuals with BDD (n=29), weight-restored AN (n=24), and healthy controls (HC) (n=31). We constructed connectivity matrices using whole-brain white matter tractography, and compared modular structures across groups. Results AN showed abnormal modularity involving frontal, basal ganglia, and posterior cingulate nodes. There was a trend in BDD for similar abnormalities, but no significant differences compared with AN. In AN, poor insight correlated with longer path length in right caudal anterior cingulate and right posterior cingulate. Conclusions Abnormal network organization patterns in AN, partially shared with BDD, may have implications for understanding integration between reward and habit/ritual formation, as well as conflict monitoring/error detection. PMID:27429183

  15. A psychological typology of females diagnosed with anorexia nervosa, bulimia nervosa or binge eating disorder

    Directory of Open Access Journals (Sweden)

    Bernadetta Izydorczyk

    2015-11-01

    Full Text Available Background The present paper reports the results of research aimed at identifying intra-group differences among females suffering from different eating disorders (anorexia nervosa, bulimia nervosa or binge eating disorder in terms of the subjects’ psychological traits, adoption of socio-cultural norms (through media pressure, internationalization of norms, and exposure to information concerning body image standards, and the level of body dissatisfaction. The following research question was asked: is it possible to distinguish specific profiles of psychological characteristics, as well as levels of body dissatisfaction, social pressure, media exposure and internalization of common standards of body image? Participants and procedure The clinical population consisted of 121 females aged 20-26. The research was conducted in the years 2007-2012. The following research methods and procedures were applied: 1 a clinical interview, 2 the Contour Drawing Rating Scale, 3 the Eating Disorder Inventory (EDI, 4 a Polish translation of the Socio-cultural Attitudes Towards Appearance Questionnaire (SATAQ-3. Results Cluster analysis of the research data allowed four significantly different clusters to be distinguished in the group of 121 examined females suffering from eating disorders. In the next step, analysis of variance (the ANOVA test was used to compare the differences between the examined clusters in terms of the investigated variables and their indicators. Conclusions Due to significant differences between the examined females in terms of the strength levels and the configuration of psychological and socio-cultural variables investigated in the present study, the females were classified into four different psychological types referred to as neurotic, perfectionist, impulsive and adolescent-narcissistic.

  16. A systematic review of physical therapy interventions for patients with anorexia and bulemia nervosa.

    Science.gov (United States)

    Vancampfort, Davy; Vanderlinden, Johan; De Hert, Marc; Soundy, Andrew; Adámkova, Milena; Skjaerven, Liv Helvik; Catalán-Matamoros, Daniel; Lundvik Gyllensten, Amanda; Gómez-Conesa, Antonia; Probst, Michel

    2014-01-01

    The purpose of this systematic review was to summarise the evidence from randomised controlled trials examining the effectiveness of physical therapy compared with care as usual or a wait-list condition on eating pathology and on physiological and psychological parameters in patients with anorexia and bulimia nervosa. EMBASE, PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, Physiotherapy Evidence Database and The Cochrane Library were searched from their inception until February, 2013. Articles were eligible if they utilised a randomised controlled trial design, compared physical therapy with a placebo condition, control intervention, or standard care and included patients with anorexia and bulimia nervosa. The methodological quality was assessed with the Jadad scale. Eight randomised controlled trials involving 213 patients (age range: 16-36 years) met all selection criteria. Three of the 8 included studies were of strong methodological quality (Jadad score≥3). Major methodological weaknesses were attrition and selection bias. The main results demonstrate that aerobic and resistance training result in significantly increased muscle strength, body mass index and body fat percentage in anorexia patients. In addition, aerobic exercise, yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive symptoms in both anorexia and bulimia nervosa patients. No adverse effects were reported. The paucity and heterogeneity of available studies limits overall conclusions and highlights the need for further research. Implications for Rehabilitation Supervised physical therapy might increase weight in anorexia nervosa patients. Aerobic exercise, massage, basic body awareness therapy and yoga might reduce eating pathology in patients with anorexia and bulimia nervosa. Aerobic exercise, yoga and basic body awareness therapy might improve mental and physical quality of life in patients with an eating

  17. Evaluation of enhanced attention to local detail in anorexia nervosa using the embedded figures test; an FMRI study.

    Directory of Open Access Journals (Sweden)

    Leon Fonville

    Full Text Available The behavioural literature in anorexia nervosa and autism spectrum disorders has indicated an overlap in cognitive profiles. One such domain is the enhancement of local processing over global processing. While functional imaging studies of autism spectrum disorder have revealed differential neural patterns compared to controls in response to tests of local versus global processing, no studies have explored such effects in anorexia nervosa. This study uses functional magnetic resonance imaging in conjunction with the embedded figures test, to explore the neural correlates of this enhanced attention to detail in the largest anorexia nervosa cohort to date. On the embedded figures tests participants are required to indicate which of two complex figures contains a simple geometrical shape. The findings indicate that whilst healthy controls showed greater accuracy on the task than people with anorexia nervosa, different brain regions were recruited. Healthy controls showed greater activation in the precuneus whilst people with anorexia nervosa showed greater activation in the fusiform gyrus. This suggests that different cognitive strategies were used to perform the task, i.e. healthy controls demonstrated greater emphasis on visuospatial searching and people with anorexia nervosa employed a more object recognition-based approach. This is in accordance with previous findings in autism spectrum disorder using a similar methodology and has implications for therapies addressing the appropriate adjustment of cognitive strategies in anorexia nervosa.

  18. Similarities and differences between excessive exercising anorexia nervosa patients compared with DSM-IV defined anorexia nervosa subtypes.

    Science.gov (United States)

    Kiezebrink, K; Campbell, D; Mann, E; Blundell, J

    2009-12-01

    This study describes anorexia nervosa (AN) patients who use excessive exercise for weight management and how this behaviour relates to the classical Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) sub-grouping of AN. The study compared 428 clinical AN patients with 119 age and gender-matched controls. The AN cases were initially dichotomised according to DSM-IV subtype criteria into restricting (RAN; N=198) and binge-purge (BPAN; N=230) anorexia. The psychometric instruments were chosen to reflect key features concerning the diagnosis of eating disorders and characteristics of eating and food behaviour and included the 26-item Eating Attitude Test (EAT-26), Three Factor Eating Questionnaire (TFEQ), Dutch Eating Behaviour Questionnaire (DEBQ), Eysenck Personality Inventory (EPI) and Rosenberg Self-Esteem scale (RSE). Structured clinical interviews (1) were carried out in order to identify the subgroup of patients who use excessive exercise in order to facilitate weight control (EAN). The three groups (RAN, BPAN, EAN) did not differ in measures of current age, current body mass index, age of onset of AN and measures of restrained eating. However, significant differences were observed on EAT-26, DEBQ emotional and external factors, TFEQ disinhibition and hunger factors, EPI extraversion and neuroticism, and self-esteem. The EAN were similar to the RAN on the majority of variables but showed significant differences on extraversion, neuroticism, self-esteem and disease pathology (EAT-26). Compared with BPAN, EAN had lower disease pathology (EAT-26 scores), scored higher on the EPI extraversion scale, lower on the neuroticism scale and had greater self-esteem. The EAN also displayed significantly lower emotional and external eating (DEBQ) than BPAN and significantly lower disinhibition and hunger scores (TFEQ). These data suggest that EAN group display a mixed profile of characteristics resembling both BPAN and RAN. When EAN are defined as

  19. Therapist adherence in the strong without anorexia nervosa (SWAN) study: A randomized controlled trial of three treatments for adults with anorexia nervosa.

    Science.gov (United States)

    Andony, Louise J; Tay, Elaine; Allen, Karina L; Wade, Tracey D; Hay, Phillipa; Touyz, Stephen; McIntosh, Virginia V W; Treasure, Janet; Schmidt, Ulrike H; Fairburn, Christopher G; Erceg-Hurn, David M; Fursland, Anthea; Crosby, Ross D; Byrne, Susan M

    2015-12-01

    To develop a psychotherapy rating scale to measure therapist adherence in the Strong Without Anorexia Nervosa (SWAN) study, a multi-center randomized controlled trial comparing three different psychological treatments for adults with anorexia nervosa. The three treatments under investigation were Enhanced Cognitive Behavioural Therapy (CBT-E), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), and Specialist Supportive Clinical Management (SSCM). The SWAN Psychotherapy Rating Scale (SWAN-PRS) was developed, after consultation with the developers of the treatments, and refined. Using the SWAN-PRS, two independent raters initially rated 48 audiotapes of treatment sessions to yield inter-rater reliability data. One rater proceeded to rate a total of 98 audiotapes from 64 trial participants. The SWAN-PRS demonstrated sound psychometric properties, and was considered a reliable measure of therapist adherence. The three treatments were highly distinguishable by independent raters, with therapists demonstrating significantly more behaviors consistent with the actual allocated treatment compared to the other two treatment modalities. There were no significant site differences in therapist adherence observed. The findings provide support for the internal validity of the SWAN study. The SWAN-PRS was deemed suitable for use in other trials involving CBT-E, MANTRA, or SSCM. The Authors. International Journal of Eating Disorders Published by Wiley Periodicals, Inc.

  20. Sudden gains in the outpatient treatment of anorexia nervosa: A process-outcome study.

    Science.gov (United States)

    Cartwright, Anna; Cheng, Yat Ping; Schmidt, Ulrike; Landau, Sabine

    2017-10-01

    Sudden gains (SGs), broadly defined as sudden symptom reductions occurring between two consecutive treatment sessions, have been associated with improved treatment outcomes in anxiety and depression. The present study is the first to formally define SGs in anorexia nervosa and explore the characteristics, demographic and baseline clinical predictors, and clinical impact of SGs in anorexia nervosa. This is a secondary analysis of data from 89 outpatients with broadly defined anorexia nervosa who received one of two psychotherapeutic interventions as part of the MOSAIC trial (Schmidt et al., 2015). SGs were defined using session-by-session body mass index (BMI) measures. This study investigated whether SGs were associated with changes in BMI, eating disorder symptomology, general psychopathology, and psychosocial impairment between baseline and 6, 12, and 24 months follow-up. SGs, experienced by 61.8% of patients, mostly occurred during the early and middle phases of treatment. A larger proportion of SGs predicted larger increases in BMI between baseline and 6, 12, and 24 months follow-up. Amongst those experiencing at least one SG, fewer days between baseline and a patient's first SG predicted a larger increase in BMI between baseline and both 6 and 12 months follow-up. The proportion and timing of SGs did not predict changes in other outcome measures. SGs in BMI during the outpatient treatment of anorexia nervosa are clinically useful predictors of longer-term weight outcomes. © 2017 Wiley Periodicals, Inc.

  1. Anticipation of Body-Scaled Action Is Modified in Anorexia Nervosa

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    Guardia, Dewi; Lafargue, Gilles; Thomas, Pierre; Dodin, Vincent; Cottencin, Olivier; Luyat, Marion

    2010-01-01

    Patients with anorexia nervosa frequently believe they are larger than they really are. The precise nature of this bias is not known: is it a false belief related to the patient's aesthetic and emotional attitudes towards her body? Or could it also reflect abnormal processing of the representation of the body in action? We tested this latter…

  2. Incidence, prevalence and mortality of anorexia nervosa and other eating disorders

    NARCIS (Netherlands)

    Hoek, Hans Wijbrand

    Purpose of review The purpose of this review is to evaluate the recent literature on the incidence and prevalence of and mortality associated with eating disorders. Recent findings General-practice studies shove that the overall incidence rates of anorexia nervosa remained stable during the 1990s,

  3. Anorexia nervosa in a girl of Chinese origin: psychological, somatic and transcultural factors.

    Science.gov (United States)

    Demarque, Mélissa; Guzman, Gabriela; Morrison, Elodie; Ahovi, Jonathan; Moro, Marie Rose; Blanchet-Collet, Corinne

    2015-04-01

    The increased prevalence of anorexia nervosa reported in non-Western societies inevitably raises the issue of the influence of cultural factors in the genesis and the patterns of this disorder. Anorexia nervosa is not a straightforward Western culture-bound syndrome, although an influence of Western ideals of thinness does exist. The illness seems more related to rapid cultural shifts, either societal or individual, such as those occurring in the migratory process. Migrants and their children have to face the acculturation process and may experience a culture-clash. The pathology can also fulfil a positive acculturative function. This is a case study concerning a second-generation Chinese girl born in France presenting with anorexia nervosa. This case leads us to raise the issue of the choice of diagnostic criteria in relation to cultural background. We will also discuss the impact of the family's migratory history on the construction of identity in adolescence. Finally we will explore the specific features of care provision for anorexia nervosa in a transcultural setting. © The Author(s) 2013.

  4. The Clinical Utility of Personality Subtypes in Patients with Anorexia Nervosa

    Science.gov (United States)

    Wildes, Jennifer E.; Marcus, Marsha D.; Crosby, Ross D.; Ringham, Rebecca M.; Dapelo, Marcela Marin; Gaskill, Jill A.; Forbush, Kelsie T.

    2011-01-01

    Objective: Elucidation of clinically relevant subtypes has been proposed as a means of advancing treatment research, but classifying anorexia nervosa (AN) patients into restricting and binge-eating/purging types has demonstrated limited predictive validity. This study aimed to evaluate whether an approach to classifying eating disorder patients on…

  5. Reversible brain atrophy and subcortical high signal on MRI in a patient with anorexia nervosa

    Energy Technology Data Exchange (ETDEWEB)

    Drevelengas, A. [Asklipios-Aristotelio Diagnostic Centre, Thessaloniki (Greece); Dept. of Radiology, AHEPA University Hospital, Thessaloniki (Greece); Chourmouzi, D.; Boulogianni, G. [Asklipios-Aristotelio Diagnostic Centre, Thessaloniki (Greece); Pitsavas, G. [Paediatric Clinic, AHEPA University Hospital, Thessaloniki (Greece); Charitandi, A. [Dept. of Radiology, AHEPA University Hospital, Thessaloniki (Greece)

    2001-10-01

    Anorexia nervosa (AN), usually seen in young girls, is characterised by severe emaciation induced by self-imposed starvation. Enlargement of the ventricular system and sulci has been reported, as has high signal on T2-weighted images. We present a case with atrophic changes and high signal on T2-weighted images, which resolved completely following weight gain. (orig.)

  6. Reversible brain atrophy and subcortical high signal on MRI in a patient with anorexia nervosa

    International Nuclear Information System (INIS)

    Drevelengas, A.; Chourmouzi, D.; Boulogianni, G.; Pitsavas, G.; Charitandi, A.

    2001-01-01

    Anorexia nervosa (AN), usually seen in young girls, is characterised by severe emaciation induced by self-imposed starvation. Enlargement of the ventricular system and sulci has been reported, as has high signal on T2-weighted images. We present a case with atrophic changes and high signal on T2-weighted images, which resolved completely following weight gain. (orig.)

  7. Epidemiology of Anorexia Nervosa in Men : A Nationwide Study of Finnish Twins

    NARCIS (Netherlands)

    Raevuori, Anu; Hoek, Hans W.; Susser, Ezra; Kaprio, Jaakko; Rissanen, Aila; Keski-Rahkonen, Anna

    2009-01-01

    Background: To examine the epidemiology of anorexia nervosa in men, we screened Finnish male twins born in 1975-79. Methods and Findings: Men (N = 2122) from FinnTwin16 birth cohorts were screened for lifetime eating disorders by a questionnaire. The screen positives (N = 18), their male co-twins (N

  8. Incidence of severe anorexia nervosa in Switzerland : 40 years of development (vol 35, pg 250, 2004)

    NARCIS (Netherlands)

    Milos, G; Spindler, A; Schnyder, U; Martz, J; Hoek, HW; Willi, J

    Objective: The current study examined the development of the incidence of severe anorexia nervosa with five sampling periods covering the years 1956-1995 in a geographically defined region of Switzerland. Method: Applying the same methodology as in the earlier sampling periods, the medical records

  9. A systematic review of studies on the faecal microbiota in anorexia nervosa

    DEFF Research Database (Denmark)

    Schwensen, Hanna Ferløv; Kan, Carol; Treasure, Janet

    2018-01-01

    PURPOSE: Anorexia nervosa (AN) is a poorly understood and often chronic condition. Deviations in the gut microbiota have been reported to influence the gut-brain axis in other disorders. Therefore, if present in AN, it may impact on symptoms and illness progression. A review of the gut microbiota...

  10. Altered food-cue processing in chronically ill and recovered women with anorexia nervosa

    NARCIS (Netherlands)

    Sanders, Nicole; Smeets, Paul A. M.; van Elburg, Annemarie A.; Danner, Unna N.; van Meer, Floor; Hoek, Hans W.; Adan, Roger A. H.

    2015-01-01

    Anorexia nervosa (AN) is a severe mental disorder characterized by food restriction and weight loss. This study aimed to test the model posed by Brooks et al. (2012a,b) that women suffering from chronic AN show decreased food-cue processing activity in brain regions associated with energy balance

  11. Altered food-cue processing in chronically ill and recovered women with anorexia nervosa

    NARCIS (Netherlands)

    Sanders, Nicole; Smeets, Paul A M; van Elburg, Annemarie A.; Danner, Unna N.; van Meer, Floor; Hoek, Hans W.; Adan, Roger A H

    2015-01-01

    Anorexia nervosa (AN) is a severe mental disorder characterized by food restriction and weight loss.This study aimed to test the model posed by Brooks et al. (2012a,b) that women suffering from chronic AN show decreased food-cue processing activity in brain regions associated with energy balance and

  12. Sleep Patterns Before and After Weight Restoration in Females with Anorexia Nervosa: A Longitudinal Controlled Study.

    Science.gov (United States)

    El Ghoch, Marwan; Calugi, Simona; Bernabè, Jasmine; Pellegrini, Massimo; Milanese, Chiara; Chignola, Elisa; Dalle Grave, Riccardo

    2016-09-01

    To assess sleep patterns in female patients with anorexia nervosa before and after weight restoration. Sleep patterns were measured objectively using a Sense Wear Armband before and after weight restoration in 50 female patients with anorexia nervosa, and in 25 healthy females. At baseline, patients with anorexia nervosa exhibited lower total sleep time and sleep onset latency than controls, the former apparently associated with baseline BMI, duration of illness and age. However, after weight restoration, total sleep time and sleep onset latency were similar to controls, despite the persistence of longer periods of wake after sleep onset. In patients with anorexia nervosa, total sleep time and sleep onset latency appears to be reduced. This sleep disturbance seems to be influenced by the duration and severity of malnutrition, and appears to normalize with weight restoration. Even though a discontinuous sleep pattern seems to persist, this finding should be discussed with patients. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

  13. The incidence of anorexia nervosa in Netherlands Antilles immigrants in the Netherlands

    NARCIS (Netherlands)

    van Hoeken, Daphne; Veling, Wim; Smink, Frederique R. E.; Hoek, Hans W.

    2010-01-01

    Objective: Previously we found that the incidence of anorexia nervosa (AN) in the general population was much lower in the Netherlands Antilles than in the Netherlands. As a follow-up we compared the incidence of AN in the Netherlands in persons from the Netherlands Antilles to native Dutch. Method:

  14. Meta analysis on the efficacy of pharmacotherapy versus placebo on anorexia nervosa.

    NARCIS (Netherlands)

    De Vos, J.; Houtzager, L.; Katsaragaki, G.; van den Berg, E; Cuijpers, P.; Dekker, J.

    2014-01-01

    Background: Anorexia Nervosa (AN) has a devastating impact on the psychological and physical well being of affected individuals. There is an extensive body of literature on interventions in AN, however more studies are needed to establish which form of pharmacotherapy is effective. The few

  15. Purging behavior in anorexia nervosa and eating disorder not otherwise specified

    DEFF Research Database (Denmark)

    Støving, René Klinkby; Andries, Alin; Brixen, Kim Torsten

    2012-01-01

    Purging behavior in eating disorders is associated with medical risks. We aimed to compare remission rates in purging and non-purging females with anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS) in a large retrospective single center cohort. A total of 339 patients...

  16. Is anorexia nervosa a neuropsychiatric developmental disorder? An illustrative case report

    NARCIS (Netherlands)

    Kerbeshian, Jacob; Burd, Larry

    2009-01-01

    We propose the concept that anorexia nervosa is a neuropsychiatric developmental disorder. In support of the concept we present a case report of a 12-year-old girl with high functioning autistic disorder who developed Tourette syndrome and obsessive-compulsive disorder. She subsequently experienced

  17. The body as a selfing device: The case of anorexia nervosa

    NARCIS (Netherlands)

    Baerveldt, C.; Voestermans, P.

    1996-01-01

    Psychology's conceptualization of anorexia nervosa illustrates how the discipline deals with the body. On the one hand, there is an emphasis on the body as a physiological apparatus. On the other hand, specific approaches such as social constructionism stress the non-physiological body as something

  18. Hyperactivity in Anorexia Nervosa : Warming Up Not Just Burning-Off Calories

    NARCIS (Netherlands)

    Carrera, Olaia; Adan, Roger A. H.; Gutierrez, Emilio; Danner, Unna N.; Hoek, Hans W.; van Elburg, Annemarie A.; Kas, Martien

    2012-01-01

    Excessive physical activity is a common feature in Anorexia Nervosa (AN) that interferes with the recovery process. Animal models have demonstrated that ambient temperature modulates physical activity in semi-starved animals. The aim of the present study was to assess the effect of ambient

  19. Seasonally bound ovopathy versus "temperature at conception" as cause for anorexia nervosa and other eating disorders.

    NARCIS (Netherlands)

    Jongbloet, P.H.; Groenewoud, J.M.M.; Roeleveld, N.

    2005-01-01

    OBJECTIVE: A preponderance of births between April and June in patients with anorexia nervosa (AN) and other eating disorders (EDs) has recently been explained by a higher environmental temperature at conception. This hypothesis, however, does not explain some other irregularities in the month of

  20. Sociocultural factors in the development of anorexia nervosa in a black woman

    NARCIS (Netherlands)

    Hoek, HW; Willemsen, E.M.C.

    Background: in an earlier study, we found that anorexia nervosa (AN) does not occur among Black women on the Caribbean island of Curacao. Method: A case report is presented of a Black Antillean woman with AN, who was referred to a center for eating disorders in The Netherlands. In Curacao, our

  1. Association study in eating disorders : TPH2 associates with anorexia nervosa and self-induced vomiting

    NARCIS (Netherlands)

    't Landt, M. C. T. Slof-Op; Meulenbelt, I.; Bartels, M.; Suchiman, E.; Middeldorp, C. M.; Houwing-Duistermaat, J. J.; van Trier, J.; Onkenhout, E. J.; Vink, J. M.; van Beijsterveldt, C. E. M.; Brandys, M. K.; Sanders, N.; Zipfel, S.; Herpertz-Dahlmann, B.; Klampfl, K.; Fleischhaker, C.; Zeeck, A.; de Zwaan, M.; Herpertz, S.; Ehrlich, S.; van Elburg, A. A.; Adan, R. A. H.; Scherag, S.; Hinney, A.; Hebebrand, J.; Boomsma, D. I.; van Furth, E. F.; Slagboom, P. E.; Herzog, W.

    Twin studies suggest that genetic factors play a substantial role in anorexia nervosa (AN) and self-induced vomiting (SV), a key symptom that is shared among different types of eating disorders (EDs). We investigated the association of 25 single nucleotide polymorphisms (SNPs), capturing 71-91% of

  2. Association study in eating disorders: TPH2 associates with anorexia nervosa and self-induced vomiting

    NARCIS (Netherlands)

    Slof-Op 't Landt, M. C. T.; Meulenbelt, I.; Bartels, M.; Suchiman, E.; Middeldorp, C. M.; Houwing-Duistermaat, J. J.; van Trier, J.; Onkenhout, E. J.; Vink, J. M.; van Beijsterveldt, C. E. M.; Brandys, M. K.; Sanders, N.; Zipfel, S.; Herzog, W.; Herpertz-Dahlmann, B.; Klampfl, K.; Fleischhaker, C.; Zeeck, A.; de Zwaan, M.; Herpertz, S.; Ehrlich, S.; van Elburg, A. A.; Adan, R. A. H.; Scherag, S.; Hinney, A.; Hebebrand, J.; Boomsma, D. I.; van Furth, E. F.; Slagboom, P. E.

    2011-01-01

    Twin studies suggest that genetic factors play a substantial role in anorexia nervosa (AN) and self-induced vomiting (SV), a key symptom that is shared among different types of eating disorders (EDs). We investigated the association of 25 single nucleotide polymorphisms (SNPs), capturing 71-91% of

  3. Association study in eating disorders: TPH2 associates with anorexia nervosa and self induced vomiting

    NARCIS (Netherlands)

    Slof-Op 't Landt, M.C.T.; Meulenbelt, I.; Bartels, M.; Suchiman, E.; Middeldorp, C.M.; Houwing-Duistermaat, J.J.; van Trier, J.; Onkenhout, E.J.; Vink, J.M.; van Beijsterveldt, C.E.M.; Brandys, M.K.; Sanders, N.; Zipfel, S.; Herzog, W.; Herpertz-Dahlmann, B.; Klampfl, K.; Fleischhaker, C.; Zeeck, A.; Zwaan, M.; Herpertz, S.; Ehrlich, S.; van Elburg, A.A.; Adan, R.A.H.; Scherag, S.; Hinney, A.; Hebebrand, J.; Boomsma, D.I.; van Furth, E.F.; Slagboom, P.E.

    2011-01-01

    Twin studies suggest that genetic factors play a substantial role in anorexia nervosa (AN) and self-induced vomiting (SV), a key symptom that is shared among different types of eating disorders (EDs). We investigated the association of 25 single nucleotide polymorphisms (SNPs), capturing 71-91% of

  4. Family lunch session: an introduction to family therapy in anorexia nervosa.

    Science.gov (United States)

    Rosman, B L; Minuchin, S; Liebman, R

    1975-10-01

    Family lunch sessions have proved a useful diagnostic and therapeutic technique in the treatment of anorexia nervosa. This paper describes the goals of these sessions and the strategies employed in the restructuring of family relationships. Data are presented illustrating changes in eating behavior of eight identified patients.

  5. When Does the "Duty to Protect" Apply with a Client Who has Anorexia Nervosa?

    Science.gov (United States)

    Werth, James L., Jr.; Wright, Kimberly S.; Archambault, Rita J.; Bardash, Rebekah, J.

    2003-01-01

    Individuals with eating disorders, especially those with anorexia nervosa, have the potential to experience significant harm and even death as a result of behaviors related to their condition. Because of this risk, the authors argue that there is a duty to protect (i.e., an obligation to take some action when a person is engaging or considering…

  6. Neural circuits underlying hyperactivity in an animal model for anorexia nervosa

    NARCIS (Netherlands)

    Verhagen, L.A.W.

    2009-01-01

    Anorexia nervosa (AN) means literally “a nervous loss of appetite” and is characterized by reduced food intake, extreme body weight loss, hypothermia, amenorrhea and emaciation. The average prevalence of AN has been reported to be 0.3% and has the highest mortality rate (>10%) of all psychiatric

  7. Familial Contributions to the Etiology and Course of Anorexia Nervosa and Bulimia.

    Science.gov (United States)

    Strober, Michael; Humphrey, Laura Lynn

    1987-01-01

    Discusses familial influences in anorexia nervosa and bulimia. Reviews descriptions of family interaction, familial correlates of course and phenomenology of symptoms, and studies of familial transmission. Concludes that certain personality factors, possibly genetically determined, predispose the individual to greater sensitivity and vulnerability…

  8. Assessment and Treatment of Anorexia Nervosa and Bulimia in School Age Children.

    Science.gov (United States)

    Peters, Carole; And Others

    1984-01-01

    Anorexia nervosa and bulimia are major concerns for high school students, especially females. These syndromes interfere with normal functioning and social development and can be life-threatening. Definitions, characteristics, symptoms, and treatment approaches for these two eating disorders are discussed, and suggestions for involvement of the…

  9. Restoring normal eating behaviour in adolescents with anorexia nervosa : A video analysis of nursing interventions

    NARCIS (Netherlands)

    Beukers, Laura; Berends, Tamara; de Man-van Ginkel, Janneke M.; van Elburg, Annemarie A.; van Meijel, Berno

    2015-01-01

    An important part of inpatient treatment for adolescents with anorexia nervosa is to restore normal eating behaviour. Health-care professionals play a significant role in this process, but little is known about their interventions during patients' meals. The purpose of the present study was to

  10. Central coherence, organizational strategy, and visuospatial memory in children and adolescents with anorexia nervosa.

    Science.gov (United States)

    Rose, Mark; Frampton, Ian J; Lask, Bryan

    2014-01-01

    The vast majority of studies in anorexia nervosa that have investigated the domains of central coherence, organizational strategy, and visuospatial memory have focused on adult samples. In addition, studies investigating visuospatial memory have focused on free recall. No study to date has reported the association between recognition memory and central coherence or organizational strategy in younger people with this disorder, yet the capacity to recognize previously seen visual stimuli may contribute to overall visuospatial ability. Therefore, we investigate these domains in children and adolescents with anorexia nervosa compared to age- and gender-matched healthy controls. There were no significant group differences in immediate, delayed, or recognition memory, central coherence, or organization strategy. When compared with controls, patients with anorexia nervosa scored significantly higher on accuracy and took significantly longer when copying the Rey Complex Figure Task. Caution must be taken when interpreting these findings due to lower-than-expected scores in memory performance in the control group and because of a potential lack of sensitivity in the measures used when assessing this younger population. For neuropsychological functions where no normative data exist, we need a deeper, more thorough knowledge of the developmental trajectory and its assessment in young people in the general population before drawing conclusions in anorexia nervosa.

  11. Theory of Mind and the Brain in Anorexia Nervosa: Relation to Treatment Outcome

    Science.gov (United States)

    Schulte-Ruther, Martin; Mainz, Verena; Fink, Gereon R.; Herpertz-Dahlmann, Beate; Konrad, Kerstin

    2012-01-01

    Objective: Converging evidence suggests deficits in theory-of-mind (ToM) processing in patients with anorexia nervosa (AN). The present study aimed at elucidating the neural mechanisms underlying ToM-deficits in AN. Method: A total of 19 adolescent patients with AN and 21 age-matched controls were investigated using functional magnetic resonance…

  12. How Schools Can Help Combat Student Eating Disorders. Anorexia Nervosa and Bulimia.

    Science.gov (United States)

    Levine, Michael P.

    This book presents a comprehensive review of anorexia nervosa and bulimia and the roles that schools can have in preventing, identifying, and treating these disorders. Chapter 1 provides an overview of student eating disorders and presents a case study of a high school student with an eating disorder. Chapter 2 discusses the nature of anorexia…

  13. Mandometer Treatment Not Superior to Treatment as Usual for Anorexia Nervosa

    NARCIS (Netherlands)

    van Elburg, Annemarie A.; Hillebrand, Jacquelien J. G.; Huyser, Chaim; Snoek, Maartje; Kas, Martien; Hoek, Hans W.; Adan, Roger A. H.

    Objective: A comparison of the efficacy of a novel treatment method for anorexia nervosa (AN), the Mandometer treatment (MT), with treatment as usual (TAU). Method: During treatment data were collected to determine weight recovery and outcome as assessed by the Morgan Russell Outcome Assessment

  14. Lifetime anorexia nervosa in young men in the community : Five cases and their co-twins

    NARCIS (Netherlands)

    Raevuori, Anu; Keski-Rahkonen, Anna; Hoek, Hans W.; Sihvola, Elina; Rissanen, Aila; Kaprio, Jaakko

    Objective: To describe patterns, comorbidity, and outcomes from a case series of anorexia nervosa (AN) among young men from the general population and their co-twins. Method: Men (N = 2,122) born between 1975 and 1979 from Finnish twin cohorts were screened for lifetime eating disorders by

  15. Investigation of Autism Spectrum Disorder and Autistic Traits in an Adolescent Sample with Anorexia Nervosa

    Science.gov (United States)

    Postorino, Valentina; Scahill, Lawrence; De Peppo, Lavinia; Fatta, Laura Maria; Zanna, Valeria; Castiglioni, Maria Chiara; Gillespie, Scott; Vicari, Stefano; Mazzone, Luigi

    2017-01-01

    This study aimed to examine the presence of Autism Spectrum Disorder (ASD) in a sample of female adolescents with Anorexia Nervosa (AN) during the acute phase of illness. We also compare the level of autistic traits, social perception skills and obsessive-compulsive symptoms in four groups: AN, ASD, and two gender- and age-matched control groups.…

  16. Childhood Risk Factors for Lifetime Anorexia Nervosa by Age 30 Years in a National Birth Cohort

    Science.gov (United States)

    Nicholls, Dasha E.; Viner, Russell M.

    2009-01-01

    Whether previously identified childhood risk factors for anorexia nervosa (AN) predict self-reported lifetime AN by age 30 is examined. The cohort confirmed four risk and two protective factors out of the 22 suggested risk factors. The study used data from the 1970 British Cohort Study.

  17. The Importance of Emotional Insight in Cognitive Behaviour Therapy for Anorexia Nervosa: An Adolescent Case Study

    Science.gov (United States)

    Rupa, Megha; Girimaji, Satish; Muthuswamy, Selvi; Jacob, Preeti; Ravi, Malavika

    2013-01-01

    Anorexia nervosa is a rare but sever psychiatric disorder in adolescence, with chronicity and death being the most feared consequence. Emotional Insight into one's problem is considered a key determinant of success in therapy. The following case study of a 14-year-old client, describes the process of therapy as it unfolded across 45 sessions. An…

  18. Family-Based Treatment for Adolescent Anorexia Nervosa: A Promising Approach?

    Science.gov (United States)

    Le Grange, Daniel

    2004-01-01

    Despite the fact that anorexia nervosa is a debilitating disorder with serious psychological and medical sequelae, few psychological treatments have been studied. Of these, interventions that involve the parents of the adolescent have proved to be most promising. This is especially true for those cases with a short duration of illness (less than 3…

  19. Comparison of Long-Term Outcomes in Adolescents with Anorexia Nervosa Treated with Family Therapy

    Science.gov (United States)

    Lock, James; Couturier, Jennifer; Agras, W. Stewart

    2006-01-01

    Objective: To describe the relative effectiveness of a short versus long course of family-based therapy (FBT) for adolescent anorexia nervosa at long-term follow-up. Method: This study used clinical and structured interviews to assess psychological and psychosocial outcomes of adolescents (ages 12-18 years at baseline) who were previously treated…

  20. Restoring normal eating behaviour in adolescents with anorexia nervosa: A video analysis of nursing interventions

    NARCIS (Netherlands)

    Beukers, L.; Berends, T.; van Ginkel, J.; van Elburg, A.A.; van Meijel, B.

    2015-01-01

    An important part of inpatient treatment for adolescents with anorexia nervosa is to restore normal eating behaviour. Health-care professionals play a significant role in this process, but little is known about their interventions during patients' meals. The purpose of the present study was to

  1. Melting down the Ice Queen : an integrative treatment of anorexia nervosa

    NARCIS (Netherlands)

    Hartogs, Bregje M A; Eikmans, Kirsten M; Bartels-Velthuis, Agna A

    2013-01-01

    A 23-year-old woman with anorexia nervosa (AN) and a strong need for control was offered an integrative treatment, empowering the patient to be an active participant and advocating shared decision-making. To emphasise this, both the therapist and patient describe their views on the therapy. The

  2. Mandometer Treatment Not Superior to Treatment as Usual for Anorexia Nervosa

    NARCIS (Netherlands)

    van Elburg, Annemarie A.; Hillebrand, Jacquelien J. G.; Huyser, Chaim; Snoek, Maartje; Kas, Martien J. H.; Hoek, Hans W.; Adan, Roger A. H.

    2012-01-01

    Objective: A comparison of the efficacy of a novel treatment method for anorexia nervosa (AN), the Mandometer treatment (MT), with treatment as usual (TAU). Method: During treatment data were collected to determine weight recovery and outcome as assessed by the Morgan Russell Outcome Assessment

  3. Skill Acquisition in Ski Instruction and the Skill Model's Application to Treating Anorexia Nervosa

    Science.gov (United States)

    Duesund, Liv; Jespersen, Ejgil

    2004-01-01

    The Dreyfus skill model has a wide range of applications to various domains, including sport, nursing, engineering, flying, and so forth. In this article, the authors discuss the skill model in connection with two different research projects concerning ski instruction and treating anorexia nervosa. The latter project has been published but not in…

  4. Reflections on involuntary treatment in the prevention of fatal anorexia nervosa: A review of five cases

    DEFF Research Database (Denmark)

    Holm, Janni Schmidt; Brixen, Kim; Andries, Alin

    2011-01-01

    OBJECTIVE: Involuntary treatment in the prevention of fatal anorexia nervosa (AN) is still controversial. METHOD: Five fatal cases of AN were identified out of 1,160 patients who attended a specialized eating disorder unit between 1994 and 2006. Information on inpatient, ambulatory, and emergency...

  5. Anorexia nervosa in a Nigerian – a case report | Unuhu | Nigerian ...

    African Journals Online (AJOL)

    Background: Anorexia Nervosa has been reported to be uncommon among the non-western populations. However the frequency of its presentation has increased world-wide. Method/Result: The case of a 19year old secondary school leaver with 2 year history of refusing food, claiming that she is too fat and progressive ...

  6. The role of leptin, melanocortin, and neurotrophin system genes on body weight in anorexia nervosa and bulimia nervosa.

    Science.gov (United States)

    Yilmaz, Zeynep; Kaplan, Allan S; Tiwari, Arun K; Levitan, Robert D; Piran, Sara; Bergen, Andrew W; Kaye, Walter H; Hakonarson, Hakon; Wang, Kai; Berrettini, Wade H; Brandt, Harry A; Bulik, Cynthia M; Crawford, Steven; Crow, Scott; Fichter, Manfred M; Halmi, Katherine A; Johnson, Craig L; Keel, Pamela K; Klump, Kelly L; Magistretti, Pierre; Mitchell, James E; Strober, Michael; Thornton, Laura M; Treasure, Janet; Woodside, D Blake; Knight, Joanne; Kennedy, James L

    2014-08-01

    Although low weight is a key factor contributing to the high mortality in anorexia nervosa (AN), it is unclear how AN patients sustain low weight compared with bulimia nervosa (BN) patients with similar psychopathology. Studies of genes involved in appetite and weight regulation in eating disorders have yielded variable findings, in part due to small sample size and clinical heterogeneity. This study: (1) assessed the role of leptin, melanocortin, and neurotrophin genetic variants in conferring risk for AN and BN; and (2) explored the involvement of these genes in body mass index (BMI) variations within AN and BN. Our sample consisted of 745 individuals with AN without a history of BN, 245 individuals with BN without a history of AN, and 321 controls. We genotyped 20 markers with known or putative function among genes selected from leptin, melanocortin, and neurotrophin systems. There were no significant differences in allele frequencies among individuals with AN, BN, and controls. AGRP rs13338499 polymorphism was associated with lowest illness-related BMI in those with AN (p = 0.0013), and NTRK2 rs1042571 was associated with highest BMI in those with BN (p = 0.0018). To our knowledge, this is the first study to address the issue of clinical heterogeneity in eating disorder genetic research and to explore the role of known or putatively functional markers in genes regulating appetite and weight in individuals with AN and BN. If replicated, our results may serve as an important first step toward gaining a better understanding of weight regulation in eating disorders. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. The long read t recovery: treatment outcome and cost among adolescents treated for anorexia nervosa in specialized care.

    Science.gov (United States)

    Silén, Yasmina; Raevuori, Anu; Sipilä, Pyry; Jüriloo, Elisabeth; Tainio, Veli-Matti; Marttunen, Mauri; Keski-Rahkonen, Anna

    We investigated factors affecting treatment outcome and cost of treatment among adolescents treated for anorexia nervosa in specialized care. Records of 47 patients with anorexia nervosa treated at the adolescent eating disorder unit were reviewed retrospectively. Individual differences in the need for treatment and cost of treatment were considerable. Nearly one third of patients required treatment at multiple wards in addition to outpatient care. The majority of costs (76%) incurred from treating a minority (29 %) of patients. Psychiatric comorbidity, particularly depression, was associated with a greater need for treatment and higher costs. The cost of treatment of anorexia nervosa is considerable, but many of those requiring intensive treatment have a favorable outcome.

  8. [Temperament and character profiles of female adolescent patients with anorexia and bulimia nervosa].

    Science.gov (United States)

    Hueg, Anne; Resch, Franz; Haffner, Johann; Poustka, Luise; Parzer, Peter; Brunner, Romuald

    2006-03-01

    Based on the personality model outlined by Robert C. Cloninger, studies in adult patient samples demonstrated that according to distinct personality profiles patients with anorexia nervosa could be differentiated from those with bulimia nervosa, as well as from healthy controls. The current study examines whether these personality-related differences also exist in adolescent patients with eating disorders and a short duration of illness. The sample studied consists of 73 consecutively admitted female patients aged 12 to 18 years, with eating disorders. The German version of the Junior Temperament and Character Inventory (JTCI) was administered to 29 patients with anorexia nervosa, restricting type (AN-R), to 16 patients with anorexia nervosa, binge-eating/purging type (AN-B), and to 28 patients with bulimia nervosa (BN). Different temperamental factors were most pronounced between AN-R and BN patients, whereas AN-B patients exhibited a personality profile between those of AN-R and BN. BN patients scored higher on Novelty Seeking but lower on Persistence than AN-R patients. In contrast to AN-R patients, both BN and AN-B patients scored lower on Self-Directedness. The current results of differential temperamental dimensions in adolescent patients with eating disorders tended to be similar to findings for adult patients, which strengthens the assumption that distinct personality factors underlie the different subtypes of eating disorders.

  9. Focus on anorexia nervosa: modern psychological treatment and guidelines for the adolescent patient

    Directory of Open Access Journals (Sweden)

    Espie J

    2015-01-01

    Full Text Available Jonathan Espie,1 Ivan Eisler2 1Child and Adolescent Eating Disorders Service, Michael Rutter Centre, South London and Maudsley Hospital Foundation NHS Trust, 2Institute of Psychiatry, King's College London, London, UK Abstract: Anorexia nervosa is a serious condition associated with high mortality. Incidence is highest for female adolescents, and prevalence data highlight a pressing unmet need for treatment. While there is evidence that adolescent-onset anorexia has relatively high rates of eventual recovery, the illness is often protracted, and even after recovery from the eating disorder there is an ongoing vulnerability to psychosocial problems in later life. Family therapy for anorexia in adolescence has evolved from a generic systemic treatment into an eating disorder-specific format (family therapy for anorexia nervosa, and this approach has been evidenced as an effective treatment. Individual treatments, including cognitive behavioral therapy, also have some evidence of effectiveness. Most adolescents can be effectively and safely managed as outpatients. Day-patient treatment holds promise as an alternative to inpatient treatment or as an intensive program following a brief medical admission. Evidence is emerging of advantages in detecting and treating adolescent anorexia nervosa in specialist community-based child and adolescent eating-disorder services accessible directly from primary care. Limitations and future directions for modern treatment are considered. Keywords: AN, evidence, family, therapy, FT-AN, inpatient, outpatient, day patient, specialist 

  10. Weight suppression predicts total weight gain and rate of weight gain in outpatients with anorexia nervosa.

    Science.gov (United States)

    Carter, Frances A; Boden, Joseph M; Jordan, Jennifer; McIntosh, Virginia V W; Bulik, Cynthia M; Joyce, Peter R

    2015-11-01

    The present study sought to replicate the finding of Wildes and Marcus, Behav Res Ther, 50, 266-274, 2012 that higher levels of weight suppression at pretreatment predict greater total weight gain, faster rate of weight gain, and bulimic symptoms amongst patients admitted with anorexia nervosa. Participants were 56 women with anorexia nervosa diagnosed by using strict or lenient weight criteria, who were participating in a randomized controlled psychotherapy trial (McIntosh et al., Am J Psychiatry, 162, 741-747, 2005). Thirty-five women completed outpatient treatment and post-treatment assessment. Weight suppression was the discrepancy between highest lifetime weight at adult height and weight at pretreatment assessment. Outcome variables were total weight gain, rate of weight gain, and bulimic symptoms in the month prior to post-treatment assessment [assessed using the Eating Disorders Examination (Fairburn et al., Binge-Eating: Nature, Assessment and Treatment. New York: Guilford, 1993)]. Weight suppression was positively associated with total weight gain and rate of weight gain over treatment. Regression models showed that this association could not be explained by covariates (age at onset of anorexia nervosa and treatment modality). Weight suppression was not significantly associated with bulimic symptoms in the month prior to post-treatment assessment, regardless of whether bulimic symptoms were examined as continuous or dichotomous variables. The present study reinforces the previous finding that weight suppression predicts total weight gain and rate of weight gain amongst patients being treated for anorexia nervosa. Methodological issues may explain the failure of the present study to find that weight suppression predicts bulimic symptoms. Weight suppression at pretreatment for anorexia nervosa should be assessed routinely and may inform treatment planning. © 2015 Wiley Periodicals, Inc.

  11. Structural and functional differences in the cingulate cortex relate to disease severity in anorexia nervosa

    Science.gov (United States)

    Bär, Karl-Jürgen; de la Cruz, Feliberto; Berger, Sandy; Schultz, Carl Christoph; Wagner, Gerd

    2015-01-01

    Background The dysfunction of specific brain areas might account for the distortion of body image in patients with anorexia nervosa. The present study was designed to reveal brain regions that are abnormal in structure and function in patients with this disorder. We hypothesized, based on brain areas of altered activity in patients with anorexia nervosa and regions involved in pain processing, an interrelation of structural aberrations in the frontoparietal–cingulate network and aberrant functional activation during thermal pain processing in patients with the disorder. Methods We determined pain thresholds outside the MRI scanner in patients with anorexia nervosa and matched healthy controls. Thereafter, thermal pain stimuli were applied during fMRI imaging. Structural analyses with high-resolution structural T1-weighted volumes were performed using voxel-based morphometry and a surface-based approach. Results Twenty-six patients and 26 controls participated in our study, and owing to technical difficulties, 15 participants in each group were included in our fMRI analysis. Structural analyses revealed significantly decreased grey matter volume and cortical thickness in the frontoparietal–cingulate network in patients with anorexia nervosa. We detected an increased blood oxygen level–dependent signal in patients during the painful 45°C condition in the midcingulate and posterior cingulate cortex, which positively correlated with increased pain thresholds. Decreased grey matter and cortical thickness correlated negatively with pain thresholds, symptom severity and illness duration, but not with body mass index. Limitations The lack of a specific quantification of body image distortion is a limitation of our study. Conclusion This study provides further evidence for confined structural and functional brain abnormalities in patients with anorexia nervosa in brain regions that are involved in perception and integration of bodily stimuli. The association of

  12. Prognostic factors and outcome in anorexia nervosa: a follow-up study.

    Science.gov (United States)

    Errichiello, Luca; Iodice, Davide; Bruzzese, Dario; Gherghi, Marco; Senatore, Ignazio

    2016-03-01

    Anorexia nervosa is an eating disorder characterized by food restriction, irrational fear of gaining weight and consequent weight loss. High mortality rates have been reported, mostly due to suicide and malnutrition. Good outcomes largely vary between 18 and 42%. We aimed to assess outcome and prognostic factors of a large group of patients with anorexia nervosa. Moreover we aimed to identify clusters of prognostic factors related to specific outcomes. We retrospectively reviewed data of 100 patients diagnosed with anorexia nervosa previously hospitalized in a tertiary level structure. Then we performed follow-up structured telephone interviews. We identified four dead patients, while 34% were clinically recovered. In univariate analysis, short duration of inpatient treatment (p = 0.003), short duration of disorder (p = 0.001), early age at first inpatient treatment (p = 0.025) and preserved insight (p = 0.029) were significantly associated with clinical recovery at follow-up. In multiple logistic regression analysis, duration of first inpatient treatment, duration of disorder and preserved insight maintained their association with outcome. Moreover multiple correspondence analysis and cluster analysis allowed to identify different typologies of patients with specific features. Notably, group 1 was characterized by two or more inpatient treatments, BMI ≤ 14, absence of insight, history of long-term inpatient treatments, first inpatient treatment ≥30 days. While group 4 was characterized by preserved insight, BMI ≥ 16, first inpatient treatment ≤14 days, no more than one inpatient treatment, no psychotropic drugs intake, duration of illness ≤4 years. We confirmed the association between short duration of inpatient treatment, short duration of disorder, early age at first inpatient treatment, preserved insight and clinical recovery. We also differentiated patients with anorexia nervosa in well-defined outcome groups according to specific clusters of

  13. Parent-focused treatment for adolescent anorexia nervosa: a study protocol of a randomised controlled trial.

    Science.gov (United States)

    Hughes, Elizabeth K; Le Grange, Daniel; Court, Andrew; Yeo, Michele S M; Campbell, Stephanie; Allan, Erica; Crosby, Ross D; Loeb, Katharine L; Sawyer, Susan M

    2014-04-08

    Family-based treatment is an efficacious outpatient intervention for medically stable adolescents with anorexia nervosa. Previous research suggests family-based treatment may be more effective for some families when parents and adolescents attend separate therapy sessions compared to conjoint sessions. Our service developed a novel separated model of family-based treatment, parent-focused treatment, and is undertaking a randomised controlled trial to compare parent-focused treatment to conjoint family-based treatment. This randomised controlled trial will recruit 100 adolescents aged 12-18 years with DSM-IV anorexia nervosa or eating disorder not otherwise specified (anorexia nervosa type). The trial commenced in 2010 and is expected to be completed in 2015. Participants are recruited from the Royal Children's Hospital Eating Disorders Program, Melbourne, Australia. Following a multidisciplinary intake assessment, eligible families who provide written informed consent are randomly allocated to either parent-focused treatment or conjoint family-based treatment. In parent-focused treatment, the adolescent sees a clinical nurse consultant and the parents see a trained mental health clinician. In conjoint family-based treatment, the whole family attends sessions with the mental health clinician. Both groups receive 18 treatment sessions over 6 months and regular medical monitoring by a paediatrician. The primary outcome is remission at end of treatment and 6 and 12 month follow up, with remission defined as being ≥ 95% expected body weight and having an eating disorder symptom score within one standard deviation of community norms. The secondary outcomes include partial remission and changes in eating pathology, depressive symptoms and self-esteem. Moderating and mediating factors will also be explored. This will be first randomised controlled trial of a parent-focused model of family-based treatment of adolescent anorexia nervosa. If found to be efficacious, parent

  14. Inpatient treatment has no impact on the core thoughts and perceptions in adolescents with anorexia nervosa.

    Science.gov (United States)

    Fennig, Silvana; Brunstein Klomek, Anat; Shahar, Ben; Sarel-Michnik, Zohar; Hadas, Arie

    2017-06-01

    Examine changes in core perceptions and thoughts during the weight restoration phase of inpatient treatment for adolescents with anorexia nervosa. Forty-four adolescents with anorexia nervosa consecutively admitted (2009-2012) to an inpatient paediatric-psychiatric unit specializing in eating disorders. The programme consisted of a complete inpatient intervention combining weight restoration by structured supervised meals with individual and group cognitive-behavioural therapy, parental training/family intervention and educational activities, followed by a half-way day-treatment weight-stabilizing phase and progressive reintroduction to the community. The study focused on changes from hospital admission to discharge in patients' responses to self-report questionnaires on eating disorder symptoms, depression, anxiety and suicidal ideation. No significant changes in core anorexic thoughts and perceptions as Body dissatisfaction, Drive for thinness, Weight concern and Shape concern were noted. However, a reduction in the general severity of eating disorder symptoms (including Restraint and Eating concern) was observed, mainly related to the treatment structure. Levels of depression significantly decreased but remained within pathological range. We also found a concerning increase in suicidal ideation not correlated with a concomitant increase in depressive symptomatology. Inpatient treatment of anorexia nervosa in adolescents does not significantly modify core anorexic thoughts and perceptions. This may explain the high relapse rates. Changes in core beliefs may be crucial for recovery and prevention of relapse in anorexia nervosa at this critical age. This study may have clinical implications for the development of better treatment strategies to target the gap between disturbed thoughts and distorted perceptions - the core aspects of anorexia nervosa and physical recovery during and after the weight restoration phase. © 2015 Wiley Publishing Asia Pty Ltd.

  15. Is hypercortisolism in anorexia nervosa detectable using hair samples?

    Science.gov (United States)

    Ritschel, Franziska; Clas, Sabine; Geisler, Daniel; Haas, Verena; Seidel, Maria; Steding, Julius; Roessner, Veit; Kirschbaum, Clemens; Ehrlich, Stefan

    2018-03-01

    Anorexia nervosa (AN) is a severe mental disorder accompanied by extensive metabolic and endocrine abnormalities. It has been associated with hypercortisolism using short-term measurement methods such as 24 h-urine, saliva, and blood. The aim of this study was to examine whether the proposed hypercortisolism in acutely underweight AN (acAN) is also reflected in a long-term measure: hair cortisol (HCC). To gain further insight, we compared hair cortisol to a well-established classical cortisol measure (24 h-urine; UCC) longitudinally in acAN. Hair samples were collected and analyzed using a LC-MS/MS-based method to provide a monthly cortisol value. We compared HCC in samples of 40 acAN with 40 pairwise age-matched healthy controls (HC) as well as 23 long-term recovered AN participants (recAN) with 23 pairwise age-matched HC (cross-sectional design). In the second part, UCC collected weekly during 14 weeks of weight-restoration therapy in 16 acAN was compared with the (time-corresponding) HCC using linear mixed models and bivariate correlations (longitudinal design). No group differences in HCC occurred comparing acAN and recAN to HC (cross-sectional study). The longitudinal analysis revealed a decrease of UCC but not HCC with weight gain. Furthermore, there was no overall significant association between UCC and HCC. Only in the last four weeks of weight-restoration therapy we found a significant moderate correlation between UCC and HCC. HCC did not reflect the expected hypercortisolism in acAN and did not decrease during short-term weight-restoration. Time-corresponding measurements of UCC and HCC were not consistently associated in our longitudinal analysis of acAN undergoing inpatient treatment. Given the drastic metabolic disturbances in acutely underweight AN our findings could be interpreted as disturbed cortisol incorporation or altered activity of 11-β-HSD-enzymes in the hair follicle. Copyright © 2017. Published by Elsevier Ltd.

  16. Anorexia nervosa and Wernicke-Korsakoff syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Dantas Clarissa R

    2010-07-01

    significant health issue for women, and the subgroup of patients with anorexia nervosa who also misuse alcohol is probably at a particular risk of developing Wernicke-Korsakoff syndrome. The present case report highlights this relevant issue.

  17. [Social phobia in anorexia nervosa: evolution during the care].

    Science.gov (United States)

    Coulon, N; Jeammet, P; Godart, N

    2009-12-01

    The links between anorexia nervosa (AN) and anxiety disorders, and particularly social phobia, are little known. However, social phobia occurs frequently in AN. Some studies have shown reduction in anxious and depressive symptomatology in AN with re-nutrition. But, to our knowledge, no work has examined the evolution of social phobia symptoms during re-nutrition in AN. To specify the links between AN, nutritional state, and social phobia. The population consisted of 2 samples and the analysis was conducted using the SPSS11.5. Sample 1 (N=24 AN) was evaluated on admission and on leaving the hospital. Our evaluation used the body mass index (BMI), the Liebowitz scale, the Mini International Neuropsychiatric Interview (MINI), and the Yale-Brown Obsessive Compulsive Scale for Eating Disorders scale (Y-BOCS-ED) respectively to evaluate or diagnose the state of malnutrition, social anxiety symptomatology, social phobia in Diagnostic and Statistical Manual-4 (DSM-IV) and anorexic symptomatology. Sample 2 (N=60) was assessed at the end of the hospitalization and then 6, 12 and 18 months later. We used the BMI, Liebowitz scale, MINI, and Eating Disorders Inventory (EDI) to assess anorexic symptomatology. In addition, the Morgan-Russell outcome assessment schedule (MR schedule) was used to assess the total clinical state of the patients. Social anxiety symptomatology and actual diagnosis decreased throughout the treatment. However, regardless of the point at which the patient received care, there was no correlation between social phobia and nutritional state, as indicated by BMI. A correlation existed between social phobia and AN symptomatology, and between social phobia and total clinical state, during the out-patient care. A component of AN-social phobia comorbidity is still questionable. Is it linked to the clinical state of the subjects (question of an additional effect of under nutrition and cognition), or even to AN? Others indicators of under nutrition are of interest

  18. Meta-analysis of theory of mind in anorexia nervosa and bulimia nervosa: A specific İmpairment of cognitive perspective taking in anorexia nervosa?

    Science.gov (United States)

    Bora, Emre; Köse, Sezen

    2016-08-01

    Deficits in theory of mind (ToM), ability to infer mental states of others, can play a significant role in interpersonal difficulties and/or unawareness of illness observed in AN and other eating disorders including bulimia Nervosa (BN). Current meta-analysis aimed to summarize available evidence for deficits in ToM in AN and BN and examine the effects of number of study-level variables on observed findings. In this meta-analysis, 15 studies (22 samples with eating disorders) investigating ToM performances of 677 individuals with AN or BN and 514 healthy controls were included. AN was associated with significant deficits in ToM (d = 0.59) which were more pronounced in the acute patients (d = 0.67). Small sized deficits in ToM were observed in BN (d = 0.34) and recovered AN (d = 0.35). Both cognitive perspective-taking (ToM-PT) (d = 0.99) and decoding mental states (ToM-decoding) (d = 0.61) aspects of ToM were impaired in acute AN. ToM-decoding impairment in BN was modest. There was no evidence for significant ToM-PT deficit in BN. Several study-level variables including longer duration of illness, lower BMI, and depressive symptoms were associated with more severe deficits in ToM in AN. ToM deficits, particularly in ToM-PT, can be a specific feature of AN but not BN. ToM impairment can contribute to poor insight, treatment resistance, and social impairment in AN. © 2016 Wiley Periodicals, Inc. RESUMEN META ANÁLISIS DE LA TEORÍA DE LA MENTE EN ANOREXIA NERVOSA Y BULIMIA NERVOSA: ¿Un deterioro de la toma de perspectiva cognitiva en Anorexia Nervosa? Las deficiencias en la teoría de la mente (ToM), la habilidad parar inferir los estados mentales de otros, pueden jugar una función significativa en las dificultades interpersonales y/o falta de reconocimiento de la enfermedad observada en Anorexia Nervosa (AN) y otros trastornos de la conducta alimentaria incluyendo la Bulimia Nervosa (BN). Los meta análisis actuales dirigidos a resumir la

  19. Is glycyrrhizin sensitivity increased in anorexia nervosa and should licorice be avoided? Case report and review of the literature

    DEFF Research Database (Denmark)

    Støving, René K; Lingqvist, Linnéa E; Bonde, Rasmus K

    2011-01-01

    low daily dose of licorice suggests high glycyrrhizin sensitivity. CONCLUSION: Patients with anorexia nervosa not only have decreased food intake but also selective and sometimes bizarre eating habits that, in association with increased sensitivity to glycyrrhizin, may cause severe hypokalemia....

  20. A comparison of eating, exercise, shape, and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa.

    Science.gov (United States)

    Murray, Stuart B; Rieger, Elizabeth; Hildebrandt, Tom; Karlov, Lisa; Russell, Janice; Boon, Evelyn; Dawson, Robert T; Touyz, Stephen W

    2012-03-01

    In the context of the lack of nosological clarity surrounding muscle dysmorphia, this paper aims to compare the symptomatic profile of muscle dysmorphia and anorexia nervosa in males whilst using measures sensitive to indexing male body image concerns. Twenty-one male muscle dysmorphia patients, 24 male anorexia nervosa patients, and 15 male gym-using controls completed the Eating Disorder Examination-Questionnaire, the Muscle Dysmorphia Disorder Inventory, the Compulsive Exercise Test, and a measure of appearance-enhancing substance use. Men with muscle dysmorphia and anorexia nervosa demonstrated widespread symptomatic similarities spanning the domains of disturbed body image, disordered eating, and exercise behaviour, whilst differences were consistent with the opposing physiques pursued in each condition. Furthermore, correlational analyses revealed significant associations between scores on muscle dysmorphia and eating disorder measures. The present findings provide moderate support for the notion that muscle dysmorphia may be nosologically similar to anorexia nervosa. Copyright © 2012 Elsevier Ltd. All rights reserved.